Potential motivators affecting parental intention in COVID-19 vaccination for children aged 6 months to 4 years: Implications for targeted vaccine interventions in Japan.

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.

[Developing scales to evaluate community practices among municipal public health nurses: content, perceptions of public health nurses, and organizational environment].

Objectives　This study aimed to develop scales for evaluating the level of implementation of community practices and explore the perception of public health nurses in municipalities regarding their community practices.Methods　Draft scales were developed based on a literature review and interviews with municipal public health nurses. Subsequently, a questionnaire survey was conducted with municipal public health nurses across Japan in response to these draft scales. Respondents were recruited based on the municipality population size. Questionnaires were distributed to 2,074 individuals from 52 municipalities ensuring representation from diverse municipalities. Exploratory factor analysis was performed to determine the number of factors, while confirmatory factor analysis was performed to determine the factor structure. The reliability of the scales was assessed by calculating Cronbach's alpha coefficients, and their validity was tested by examining correlations with existing scales, namely the Moral Competence Scale for Public Health Nurses and the Professional Identity Scale for Public Health Nurses, and years of experience as a public health nurse.Results　A total of 721 (34.8%) valid respondents were included in the analysis. Three scales, methods of community practices (three factors, nine items), perceptions of public health nurses toward community residents through community practices (three factors, 10 items), and organizational environment supporting community practices (two factors, 11 items) were developed as indicators of the implementation of public health nurses' community practices. Cronbach's alpha coefficients for the three scales were 0.896, 0.913, and 0.868, respectively. As hypothesized, each subfactor exhibited a positive correlation with the existing scales. However, certain subfactors did not demonstrate any correlation with years of experience.Conclusion　The three scales developed in this study were individually examined for reliability and validity. These scales can be used independently or in combination, allowing public health nurses to select the most suitable scale(s) based on their objective.　A notable contribution of this study is the establishment of concrete indicators for evaluating community practices, addressing the previously vague nature of this evaluation. By incorporating the scale items into daily health practices, we anticipate that these indicators can be employed to evaluate community practices at the organizational and individual levels.

Age Group Differences in Daily Life Changes among Community Residents during the COVID-19 Pandemic: A Pilot Study on Intergenerational Comparison.

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.

[Gaining consensus on key terms in community health activities: A national survey using the Delphi method].

Objectives　The purpose of this study was to define the terminology used in community health activities by systematically establishing agreement among public health nurses and related professionals, to aid them in effectively cooperating with other professionals.Methods　We extracted the major terms described in "Guidelines for Public Health Nurses' Activities in the Region," which was issued by the Director of Health Bureau, Ministry of Health, Labor and Welfare; and conducted 2 iterations on the proposed definition of the terms using the Delphi method. The survey targeted 800 stakeholders from the following 4 professions: public health nurses in managerial positions in local governments, clerical staff in local governments, public health nursing professors at educational institutions, and social welfare council staff. Respondents indicated their degree of agreement with the definition of the terms using a 4-point Likert scale. We tallied the answers indicating "I agree" or "Mostly agree." A 70% term agreement was considered "conformed." A free text box for each proposed definition was also available so that respondents could share their opinions and offer alternatives.Results　The first survey received 231 responses. The conformity of their definitions ranged from 83.9%-96.9% (mean=91.5%). Although all definitions exceeded the consensus level, we examined their adequacy with reference to the definitions and opinions from the free text. Various opinions were obtained from those engaged in each occupation. The second round included 117 consenting stakeholders from the first survey, yielding 90 responses. Their degree of conformity ranged from 86.7%-98.9% (mean=94.6%). Therefore, we determined the definitions had reached a robust agreement. We revised the definitions of some terms with reference to the opinions from the free texts and finalized the definitions. Finally, we defined 23 terms-such as region, community diagnosis, and policy.Conclusion　All terms had a conformity of more than 85%, thus bringing into alignment those community health terms that had varying interpretations among related occupations earlier. By including the opinions of those from the related occupations who collaborate with public health nurses, the definitions of these terms could be established and shared. These definitions can be used in public health nursing practice, education, service, and research-among those in involved these related occupations.

A Logic Model for Evaluation and Planning in an Adult Day Care for Disabled Japanese Old People.

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.

Home safety practices to prevent child injury and its association with family and children's daily routines in Japan: A cross-sectional study.

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.

The structure of the perceived professional identity of Japanese public health nurses.

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.

Improved parental attitudes and beliefs through stepwise perinatal vaccination education.

This study examined the effects of providing vaccination education during the perinatal period on Japanese parents' knowledge, attitudes, and beliefs about childhood vaccination. A cluster-randomized controlled-trial method was used on a sample of 160 pregnant women recruited from 9 obstetrical sites in Niigata, Japan. The treatment group received a stepwise interactive education intervention, while the control group received a general vaccination leaflet. Changes in parental attitudes toward and beliefs about infant vaccination were assessed on the child's one-month and 6-month birthdays using paper questionnaires. Of the initial 188 participants, 160 (90.4%) completed the final post-survey questionnaire. Scores on injunctive social norms (a morally neutral perception of the behavior of the majority) and descriptive social norms (a moral perception of what individuals should do) significantly increased in the treatment group (p = .02 and p = .01, respectively). There was a significant difference between the 2 groups over time in terms of perceived benefit (efficacy of available preventive actions) (p = .03), but no significant differences in perceived severity (seriousness of a disease outcome), perceived susceptibility (likelihood of getting a disease), perceived benefits, perceived behavioral control, or descriptive social norms between the groups at any time point or in the patterns of change over time (p > .31). Thus, stepwise perinatal vaccination education was found to positively influence maternal attitudes and beliefs about infant vaccination. This study suggests the importance of vaccination education during the perinatal period.

The Importance of the Maternal/Self-Role Satisfaction for Reducing Anxiety: A Cross-Sectional Survey of Japanese Mothers.

Women who rear children have two types of roles: the maternal role and the self-role. Previous studies have suggested that maternal role satisfaction is related to anxiety, but the importance of self-role satisfaction in promoting the health of mothers has received less attention. The changing roles of women in society, especially in urban areas, have altered mothers' views of child-rearing. Our primary focus was on the relationship between maternal/self-role satisfaction and anxiety in mothers. To examine this, we conducted a cross-sectional survey using self-administered questionnaires that were distributed in 2011 to 2,342 mothers attending the 18-month health checkup of their children, in 7 cities of the Tokyo metropolitan area. A total of 881 responded (effective response rate = 38.0%). Multiple regression analysis revealed that maternal role satisfaction and self-role satisfaction were both significantly and negatively associated with anxiety. Thus, self-role satisfaction should be considered alongside maternal role satisfaction in evaluating and reducing anxiety. Health care professionals in community settings should conduct comprehensive assessments of maternal role satisfaction and self-role satisfaction.

Measurement of special access to home visit nursing services among Japanese disabled elderly people: using GIS and claim data.

BACKGROUND: Home care service demands are increasing in Japan; this necessitates improved service allocation. This study examined the relationship between home visit nursing (HVN) service use and the proportion of elderly people living within 10 min' travel of HVN agencies. METHODS: The population of elderly people living within reach of HVN agencies for each of 17 municipalities in one low-density prefecture was calculated using public data and geographic information systems. Multilevel logistic analysis for 2641 elderly people was conducted using medical and long-term care insurance claims data from October 2010 to examine the association between the proportion of elderly people reachable by HVNs and service usage in 13 municipalities. Municipality variables included HVN agency allocation appropriateness. Individual variables included HVN usage and demographic variables. RESULTS: The reachable proportion of the elderly population ranged from 0.0 to 90.2% in the examined municipalities. The reachable proportion of the elderly population was significantly positively correlated with HVN use (odds ratio: 1.938; confidence interval: 1.265-2.967). CONCLUSIONS: Residents living in municipalities with a lower reachable proportion of the elderly population are less likely to use HVN services. Public health interventions should increase the reachable proportion of the elderly population in order to improve HVN service use.

The association between nurses' coordination with physicians and clients' place of death.

AIM: Over 60% of Japanese people hope to die at home; hence, assisting clients in achieving this outcome is an important responsibility of home care providers. This study investigated the effects of nurses' relational coordination with physicians on clients' place of death in home visiting nursing (HVN) agencies. METHOD: Secondary analysis of a public survey conducted in 2015 by local governments in Kurume city, Fukuoka prefecture, Western Japan. Manager nurses from 17 HVN agencies provided data about themselves and their relational coordination with community physicians and 85 deceased clients. RESULTS: Among 85 deceased clients, 52 (61.2%) had died at home. Four regression models showed significant positive effects of HVN nurse managers' relational coordination on clients' home death (the odds ratios (95% CI) were 2.488 (1.442-4.293), 2.111 (1.014-4.396), 2.562 (1.409-4.658) and 2.275 (1.079-4.796) in models 1-4, respectively. CONCLUSION: Measuring relational coordination among HVN nursing managers and physicians indicated readiness for home death among HVN clients in an agency or community.

Effect of stepwise perinatal immunization education: A cluster-randomized controlled trial.

BACKGROUND: Perinatal immunization education is important for improving the immunization outcomes of infants; however, the content of educational materials used at each perinatal period has not been carefully evaluated. We hypothesized that stepwise education offered at different perinatal periods would improve infant immunization status and enhance maternal immunization knowledge. METHODS: In this cluster-randomized controlled trial, pregnant women were recruited from nine obstetric sites in Niigata, Japan. The intervention group received a stepwise, interactive education intervention (prenatally, postnatally, and 1month after birth). The control group received a leaflet containing general information on immunization. Infant immunization status was evaluated at 6months of age, and maternal immunization knowledge was evaluated by a written survey after each intervention. RESULTS: Among 188 study participants, 151 (80.3%) replied to the final post-intervention survey. At 6months of age, the percentage of children who completed three doses of inactivated polio, diphtheria, tetanus toxoid, and acellular pertussis (DTaP-IPV) vaccine was higher in the intervention group than in the control (p=0.04); however, no differences between groups were observed for the Haemophilus influenzae type b (Hib) (p=0.67) or 13-valent pneumococcal conjugate (PCV13) vaccines (p=0.20). The duration to the completion of the third dose of the DTaP-IPV, Hib, and PCV13 vaccines was shorter in the intervention group than in the control (p=0.03, p<0.01, and p<0.01, respectively). Furthermore, maternal knowledge scores exhibited significantly greater improvement in the intervention group over time compared with those of the control group (p=0.02). CONCLUSIONS: Stepwise perinatal immunization education improved immunization schedule adherence for required vaccines and improved maternal immunization knowledge.

Relationship between maternal mindfulness and anxiety 1 month after childbirth.

AIM: To investigate the relationship between maternal mindfulness and maternal anxiety 1 month after childbirth. METHODS: A cross-sectional design was used, featuring anonymous questionnaires that were completed between July and December 2014 at two Japanese hospitals. The participants (n = 151) completed the Mindful Attention Awareness Scale (Japanese version) and the State-Trait Anxiety Inventory Form X (Japanese version). The data analysis was carried out by using a hierarchical multiple regression. RESULTS: The state and trait anxiety scores showed significant relationships with mindfulness, the mother's age, and the perceived difference between the expectations of motherhood before childbirth and the reality of post-partum daily life. Furthermore, the amount of average sleep time in the past week (including naps) showed a negative association with the state anxiety score, whereas the marital relationship showed a positive association with trait anxiety. Finally, at 1 month post-partum, the mothers with greater mindfulness scores showed lower anxiety. CONCLUSIONS: Improvements in mindfulness could help mothers to reduce their post-partum anxiety.

Factors related to physical violence experienced by parents of persons with schizophrenia in Japan.

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$20K as compared to over US$40K), and higher hostility and criticism of family interactions. Family violence maybe reduced through education on communication strategies for both parents and patients.

Conformity to the neighborhood modifies the association between recreational walking and social norms among middle-aged Japanese people.

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.

Current trends and age-based differences of unintentional injury in Japanese children.

Unintentional injury in children is a worldwide public health problem, as it increases the health burden and is a leading cause of death among children. It is important to understand the differences between different age groups of children in regard to unintentional injury, in order to effectively implement child safety education. The present study aimed to determine the current trends of unintentional injury in children, and to identify the differences between different age groups of children with regard to unintentional injury. We identified 1,521 children who attended an 18-month health checkup (18-month group), and 1,368 children who attended a 36-month health checkup (36-month group), between January 1, 2014 and December 31, 2014. The rate of hospital visits associated with unintentional injury was 10.6% (161/1,521) in the 18-month group, and 13.1% (180/1,368) in the 36-month group. In both groups, present/past illness was associated with hospital visits, and in the 36-month group, hospital visits were more common in boys than in girls. The number of unintentional injuries that occurred outdoors was higher in the 36-month group than in the 18-month group. Unintentional injuries resulting from accidental ingestion and falls were more common in the 18-month group, while unintentional injuries resulting from turning over were more common in the 36-month group. In conclusion, the number of hospital visits for unintentional injury might be higher, and the number of preventive actions taken by mothers might be lower, among children attending the 36-month health checkup than among those attending the 18-month health checkup.

Effects of relational coordination among colleagues and span of control on work engagement among home-visiting nurses.

AIM: Home-visiting nursing agencies are required to foster staff nurse's work engagement; thus, the factors related to work engagement require identification. This study examined relational coordination among colleagues and agency span of control on the work engagement of home-visiting nurses. METHODS: Cross-sectional data from 93 staff nurses in 31 home-visiting nursing agencies were collected via a survey and analyzed using mixed linear regression. RESULTS: There was no significant main effect of relational coordination among nurse colleagues on work engagement. In large agencies with a large span of control, relational coordination among nursing colleagues predicted work engagement. Nursing managers' relational coordination was found to be positively associated with staff nurse work engagement. CONCLUSION: Agency span of control is a moderating factor on the positive effect of relational coordination with nursing colleagues on staff nurse work engagement.

Relational coordination among home healthcare professions and goal attainment in nursing care.

AIM: To examine whether interprofessional coordination is related to goal attainment in home visit nursing care. METHODS: Self-administered questionnaire surveys were administered to home visit nursing agencies in Chiba Prefecture, Japan, from July to December 2014. Nurses evaluated their interprofessional coordination with professional groups (nursing colleague and managers, home doctors, care managers, home care workers, visiting therapists, day service and day care professionals, visiting bath professionals, and short stay professionals) using the Japanese version of the Relational Coordination Scale (RCS-J). Goal attainment across all clients during the most recent 3 months was measured with a rating scale ranging from incompletely attained (0) to completely attained (10). Data were analyzed with multivariate logistic regression analysis. RESULTS: A total of 83 nurses in 14 agencies responded, and data from 74 nurses were analyzed. The mean RCS-J and goal attainment scores were 3.59 (standard deviation = 0.47) and 6.51 (1.40), respectively. The RCS-J scores of the low and high goal attainment groups were 3.41 (0.46) and 3.73 (0.42), respectively. Multivariate logistic regression analysis revealed that RCS-J scores were positively associated with goal attainment (odds ratio, 5.71; 95% confidence interval, 1.65-19.79). CONCLUSION: The finding of this study suggest that well-coordinated professionals may fulfill client needs better than poorly coordinated professionals do. Future research is needed to determine whether similar results are obtained in individual clients using a well-validated goal attainment scale.

Who prefers to age in place? Cross-sectional survey of middle-aged people in Japan.

AIM: Preference for aging in place among middle-aged people is an important element in estimating the future needs for community services of disabled older adults. Drawing on Litwak and Longino's typologies of relocation, the present study investigated the characteristics of middle-aged adults who prefer to age in place and those who prefer to move, at two levels of disability: being unable to walk alone and being bedridden. METHODS: In the present cross-sectional study, an anonymous, self-administered questionnaire was sent to 2500 community-dwelling adults aged 40-64 years. RESULTS: If unable to walk outside alone, 43.0% of respondents would prefer to move from their own homes. If bedridden, 29.5% preferred to move. After age and sex had been adjusted for, house size, length of time living at that house, the number of people living together, and attachment to home and neighborhood were independently related to moving preferences if unable to walk outside alone. Accessibility of hospitals and supermarkets, community participation, and use of the Internet were related to moving preferences if bedridden. CONCLUSIONS: Sex, current living arrangement and geographic properties are correlated with changes in community-dwelling adults' preferences for residential relocation as physical function declines. It is necessary for municipal policymakers to understand these correlations in order to plan and develop effective community care systems. Geriatr Gerontol Int 2016; 16: 631-637.

Current practices and needs regarding perinatal childhood immunization education for Japanese mothers.

BACKGROUND: Accurate, standardized information on childhood immunization is not available in Japan. We investigated current practices in perinatal childhood immunization education in the community and the needs and interest for such education among Japanese mothers. METHODS: This cross-sectional, descriptive study evaluated pregnant and postnatal women at four institutions in Niigata, Japan from May through July 2014. Data were collected using questionnaires inquiring about demographics, immunization education received, intent to receive childhood vaccines, and needs regarding information on childhood immunization. RESULTS: Questionnaires were distributed to 300 women, and 116 (38.6%) were returned; 70 (59.6%) of the respondents were pregnant women and 46 (40.3%) were postnatal women. Fourteen (20%) of the 70 pregnant women reported receiving some form of immunization education; in contrast, 34 (73.9%) of 46 postnatal women had received such education within 1 month of delivery. The rates of respondents who felt that the information was insufficient were high: 78.6% among pregnant women and 52.9% among postnatal women. Pregnant women reported that the most important information was general concepts of immunization; in contrast, postnatal women desired more-detailed information, e.g., on immunization scheduling. CONCLUSIONS: Japanese women do not receive sufficient perinatal immunization education. The information needed during the prenatal and postnatal periods differs. Thus, educational approaches may need to provide carefully targeted information.