[Core values and competencies of public health nurses: A Delphi survey].

Objectives　This study aimed to clarify the core values and competencies of public health nurses (PHNs) who contribute to improve health issues in transitioning societies, based on a consensus among PHN-related organizations, including practitioners and education researchers.Methods　A draft defining the core values and competencies of PHNs was developed through five consultation sessions with 20 executives and nominees of organizations in each area of PHN practice, education, and research to collect, categorize, and refine the items. The expert panel comprised 534 nominees from six PHN-related organizations, and three rounds of Delphi surveys were conducted. The consensus criteria were ≥70% for agreement and ≥80% for firm agreement.Results　In the first round, 272 expert panel nominees (50.9%) responded, and 217 responded in all rounds. The draft was revised based on the feedback from each round. By round 3, >90% agreed on the core value and competency frameworks and definitions.Conclusion　The Delphi survey revealed the three core value frameworks and definitions of "social justice in health," "human rights and autonomy," and "health and safety" and eight core competencies of "professional autonomy and responsibility," "scientific research and use of information science and technology," "population-based assessment and analysis," "practices for health enhancement and prevention," "building systems to improve public health," "management of healthy community development," "person/community-centered collaboration and cooperation," and "communication for consensus and solutions," with a firm agreement. Eventually, these frameworks would be the bases for creating national standards of practice, education, and research to satisfy the consensus levels of PHNs and PHN-related organizations.

Development of a community's self-efficacy scale for preventing social isolation among community-dwelling older people (Mimamori Scale).

BACKGROUND: Among older people in developed countries, social isolation leading to solitary death has become a public health issue of vital importance. Such isolation could be prevented by monitoring at-risk individuals at the neighborhood level and by implementing supportive networks at the community level. However, a means of measuring community confidence in these measures has not been established. This study is aimed at developing the Community's Self-Efficacy Scale (CSES; Mimamori scale in Japanese) for community members preventing social isolation among older people. METHODS: The CSES is a self-administered questionnaire developed on the basis of Bandura's self-efficacy theory. The survey was given to a general population (GEN) sample (n = 6,000) and community volunteer (CVOL) sample (n = 1,297). Construct validity was determined using confirmatory factor analysis. Internal consistency was calculated using Cronbach's alpha. The Generative Concern Scale (GCS-R) and Brief Sense of Community Scale (BSCS) were also administered to assess criterion-related validity of the CSES. RESULTS: In total, 3,484 and 859 valid responses were received in the GEN and CVOL groups, respectively. The confirmatory factor analysis identified eight items from two domains-community network and neighborhood watch-with goodness of fit index = 0.984, adjusted goodness of fit index = 0.970, comparative fit index = 0.988, and root mean square error of approximation = 0.047. Cronbach's alpha for the entire CSES was 0.87 and for the subscales was 0.80 and higher. The score of the entire CSES was positively correlated with the GCS-R in both the GEN (r = 0.80, p < 0.001) and CVOL (r = 0.86, p < 0.001) samples. CONCLUSIONS: The CSES demonstrated adequate reliability and validity for assessing a community's self-efficacy to aid in its preventing social isolation among older people. The scale is potentially useful for promoting health policies, practices, and interventions within communities. This may help prevent social isolation among older people and contribute to overall well-being in aging societies in Japan and abroad.

Development of a community commitment scale with cross-sectional survey validation for preventing social isolation in older Japanese people.

BACKGROUND: Elderly social isolation could be prevented by facilitating communication or mutual helping at the neighborhood level. The helping of elderly neighbors by local volunteers may relate to their community commitment (CC), but ways to measure CC have not been identified. The aim of the present study was to develop a Community Commitment Scale (CCS) to measure psychological sense of belonging and socializing in the community among local volunteers, for research in prevention of elderly social isolation. We also tested the CCS in a general population of the elderly. METHODS: A pilot test of 266 Japanese urban residents was conducted to examine face validity for 24 identified items, of which 12 items were selected for the CCS, based on a 4-point Likert-type scale. The CCS was developed via self-report questionnaires to 859 local volunteers in two suburban cities and to 3484 randomly sampled general residents aged 55 years or older living in one of the cities. To assess concurrent validity, data were collected using the Brief Sense of Community Scale (Peterson; 2008) and two types of single questions on self-efficacy for helping elderly neighbors. RESULTS: Item analysis and factor analysis identified 8 items, which were classified between two datasets under the domains of "belonging" and "socializing" in the local volunteers and the general residents. Cronbach's alpha (which conveyed the internal consistency of the CCS) was 0.75 in local volunteers and 0.78 in general residents. The correlation coefficients between the scores of the CCS and BSCS were 0.54 for local volunteers and 0.62 for general residents. ANOVA comparing the CCS between the confidence levels of the two types of single question of self-efficacy on helping elderly neighbors showed a strong relationship in the volunteers and residents. CONCLUSIONS: These results demonstrate acceptable internal consistency and concurrent validity for the CCS, with the two dimensions "belonging" and "socializing", among the local volunteers and general residents in urban Japanese areas. Community commitment measured by the CCS was related to the degree of confidence for self-efficacy in helping elderly neighbors to prevent elderly social isolation.

[Health behavior for prevention of knee pain among young-old persons living in a rural area: focus on presence of knee pain and sex differences].

OBJECTIVES: To determine the prevalence of knee pain, and implementation status of health behavior for knee pain among young-old persons living in a rural area in Japan by sex, and to study related factors. METHODS: An anonymous self-administered questionnaire covering demographic variables, lifestyle such as smoking, drinking, farm work, snow removal, 'ochanomi' (tea break with friends), hospital visits, knee pain, JKOM (Japanese knee osteoarthritis measure) and health behavior was distributed to 2,758 persons aged 65 to 74 years living in Minamiaizu town, a rural and snowy town of Fukushima Prefecture in November, 2008. RESULTS: Valid responses were obtained from 1,415 (response rate: 51.3%). The prevalence of knee pain was 35.1%, and twice as many women as men had pain in their knees. People with knee pain had a higher body mass index, higher risk of motor deterioration, lower frequency of going out, and more hospital visits than people without knee pain. Health behavior was emphasized by 657 persons (46.3%), and the rate was higher in people with knee pain. As to companions and information source for health behaviors, 'ochanomi' friends were popular for women and family members for men. Walking was more common and exercise and diet were less common in men than in women. Among the women with knee pain, the implementation rate of health behavior was higher in non-smokers, farm workers, and 'ochanomi' participants than in others. Among men without knee pain, the implementation rate was higher in non-smokers and in people with high scores on the JKOM subscale of "pain or stiffness" and "health status". Among women without knee pain, more people living alone and going out once or more a week focused on health behavior more than the other people. CONCLUSION: The prevalence of knee pain in this study was similar to that in a previous study on elderly living in a mountain area. Type, information source, companion and related factors of health behavior differed by sex and presence of knee pain; therefore, approaches for encouraging health behavior should be suited to the target population's characteristics. Many people obtain information from non-professionals, so health care workers should provide details about adequate methods for health behavior in a careful manner.

[Study on dilemma and strategy of community support network by community organization for prevention of isolated death in an urban area].

OBJECTIVES: Isolated death of elderly is recognized as a severe social problem in public health and it is an urgent requirement that a supportive community network be organized so that its occurrence is minimized. The purpose of this research was to analyze actual issues of a supportive community network for elderly within the community and to obtain clues for useful actions to prevent isolated death of elderly individuals in the future. METHODS: The subjects were 14 representatives of a supportive community network for elderly in A City, B Ward and C District (as a junior high school segment). The research was conducted with a qualitative inductively approach using the Focus Group Interview (FGI). Interviews were focused on difficulties and perspectives within their daily support activities in the community, and were held three times during October 2009 to March 2010. The FGI records were then analyzed with meaningful minimal words and sentences, categorized codes, and then those codes were classified into subcategories or categories. RESULTS: Three categories, Individual, Neighborhood and Community network for elderly resulted from the analysis. Regarding difficulties, "Refusing supports or indifference", "Isolation or Tojikomori in the youth generation", "Lack of family support", "Relationships among their residents weakening gradually", "Unfamiliar newcomers and residents", "Residence feels burden on association with neighborhood", "Limitation of support activities under personal security", "Lack of resources for persons and places of gathering" were identified. On the other hand, perspectives in the community network for elderly were "Building relationships personally", "Invitation to community meetings as companions", "Development of safety confirmation", "Helping each other in the neighborhood", "Stimulate enforcement of bonding in daily life", "Making arrangements for regional administration and residents for supportive activites", "Fostering the trust and connection of residence". CONCLUSION: To further promotion and effective activities for community network for elderly by community residents, it is necessary that information be exchanged among resident organizations regarding their activities in achievement of social cooperation.