[Need for livelihood support and relationship with community residents: A cross-sectional survey among older adults who do not use livelihood support in a rural area].

Objectives　In recent years, the Japanese government has promoted a livelihood support system based on residents-based mutual help in the community. This study aimed to examine the associations between the need for livelihood support and the relationship with community residents among older adults who do not use livelihood support in a rural area. We operationally defined livelihood support as helping older adults with daily problems so that they can continue to live in familiar neighborhoods.Methods　A self-administered questionnaire survey was conducted in Gejo Area of Tokamachi City, Niigata Prefecture in October 2018. The questionnaires were distributed to all 1,033 residents aged 65 years or over, excluding those certified with care levels 3-5 in the long-term care insurance system. The survey items included basic characteristics, health status, relationship with community residents, and need for 33 livelihood support items.Results　A total of 802 questionnaires were returned (response rate of 77.6%), and 653 community-dwelling individuals who had not used livelihood support were included in the analysis. Factor analysis grouped the 33 livelihood support items into four factors: temporary problems and troubles (53.4%), participation in events and gatherings (38.0%), daily household chores (31.7%), and small problems in daily life (27.7%). Logistic regression analysis showed that the need for assistance with temporary problems and troubles was related to "low trust in community residents," "willing to help community residents but have not yet done so," and "willing to help community residents and have already done so." The need for assistance with participation in events and gatherings was related to "willing to help community residents but have not yet done so," "willing to help community residents and have already done so," and "higher levels of sekentei." The need for assistance with daily household chores was related to "low trust in community residents" and "willing to help community residents and have already done so." Finally, the need for assistance with small problems in daily life was related to "willing to help community residents and have already done so."Conclusion　The need for livelihood support was related to relationships with community residents. To promote the livelihood support system in communities, the relationships between older adults and community residents should be considered.

Mental health and current issues of migrant workers in Japan: A cross-sectional study of Vietnamese workers.

BACKGROUND: Over the past 5 years, the number of Vietnamese migrant workers in Japan has grown rapidly to become the largest group of migrant workers in the country. They hold various statuses of residence and are subjected to multifactorial stressors. AIMS: The current study's aim is to investigate the association between psychological distress experienced by Vietnamese workers and their work environment. Another aim is to discuss issues involving migrant workers by comparing the characteristics of workers in the major statuses of residence. METHODS: The study applied a cross-sectional design, and included a nationwide self-administered online questionnaire that was conducted in Vietnamese in 2022. The questionnaire included the Kessler Psychological Distress Scale (K10), workplace interpersonal factors as well as factors related to work and health. A multiple logistic regression analysis was conducted to investigate factors associated with psychological distress. RESULTS: Of 933 Vietnamese workers, 37% were grouped as distressed under the K10 cutoff. Fewer opportunities to speak with Japanese co-workers, lower welfare and workload ratings, and the visa statuses including 'Technical Intern Training' were significantly associated with psychological distress. Unexpectedly, those in 'Engineer/Specialist in Humanities/International Services (ESI)' category who are deemed to hold better conditions demonstrated the highest amounts of distress. CONCLUSION: Outside of unsatisfactory working environments, differing situations depending on status of residence could produce various sources of distress. The difficult aspects of Japan's distinct culture seem to contribute to their distress, especially for those who have more interactions with Japanese co-workers. A push for a multicultural society, where migrant workers can pursue proactive life designs of their own choosing, is warranted.

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.

Message framing effects on attitude and intention toward social participation in old age.

BACKGROUND: Message framing is frequently used to advocate health perceptions and behaviors. The effects of message framing on various health behaviors have been examined; however, its effects on social participation, a key determinant of healthy aging, are unclear. This study investigated the effects of message framing on older adults' attitudes and intentions toward social participation. METHODS: A questionnaire survey conducted in 2020 targeted community-dwelling people aged ≥ 65 years in two rural areas in Japan. Participants were randomly allocated to four groups according to the types of framed messages to promote social participation activities: "private gain-framed message," "private loss-framed message," "public gain-framed message," or "no message." Outcomes included attitudes and intentions toward social participation (impression, interest, and readiness for social participation activities). RESULTS: A total of 1,524 participants were analyzed (men: 46.3%; average age: 75.7 ± 7.9 years). Ordinal logistic regression analyses of individuals who engaged in any social participation activity showed no significant intergroup difference in the outcomes after adjusting for potential covariates. Among people who did not engage in any activity, the private loss-framed message was associated with a more favorable impression and higher interest and readiness than no message. The private gain-framed message was related to a higher interest in social participation. CONCLUSIONS: Private loss-framed messages are possibly most effective in reinforcing attitudes and intentions toward social participation, particularly among individuals without social participation experience. These findings highlight the possibility of using a message-framing approach to promote social participation in older adults.

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.

Association between Japanese community health workers' willingness to continue service and two categories of motives: Altruistic and self-oriented.

BACKGROUND: As population aging progresses, volunteers in health field are expected to play a key role in health promotion and disease prevention, which may improve community residents' health and well-being and at the same time help slow the growth of healthcare cost. The objective of this study is to examine the effects of self-oriented motives and altruistic motives as explanatory factors for Japanese Community Health Workers (CHWs)' desire to continue their service. Unraveling the relative effects of these two types of motivation on CHW retention may lead to policy and practical implications for recruiting, training, and supporting CHWs in Japan. Haddad (2007) observed that citizens in Japan generally have a sense of governmental and individual responsibility for dealing with social problems. Applying these insights to CHWs, we hypothesize that altruistic motives have more potent influence on volunteers' willingness to continue to serve than self-oriented motives. METHODS: Three cities in Shiga prefecture, Japan agreed to participate in the study. Anonymous, self-administered questionnaire was mailed to all CHWs who work in the three communities. The survey data were collected in March and April, 2013. A total of 417 questionnaires were mailed to CHWs, of which 346 were completed and returned (response rate 83.0%). Nine questionnaires missing response to the question concerning willingness to continue serving were removed from the analysis. The final analysis used 337 questionnaires (effective response rate 80.8%). RESULTS: One hundred ninety-nine (59.1%) of the respondents answered the question about willingness to continue CHW affirmatively, and 138 (40.9%) negatively. Controlling for other relevant factors, those with self-oriented motives in serving as CHWs were more likely to state they are willing to continue to serve (OR:1.54, confidence interval 1.00-2.37) than those without such motives. Those with altruistic motives were also more likely to say they want to continue their service (OR 1.56, confidence interval 1.08-2.27) than those without such motives. Contrary to our hypothesis, the two motives, altruistic and self-oriented, were shown to have nearly equal degree of influence on respondents' willingness to continue serving as CHWs. CONCLUSION: One practical implication of the research is that learning more about the twin motives, self-oriented and altruistic, of volunteers and tailoring the content of CHW training by municipal health professionals to address those motives may be beneficial.

Preliminary Effect and Acceptability of an Intervention to Improve End-of-Life Care in Long-Term-Care Facilities: A Feasibility Study.

The number of deaths of older adults in long-term care settings will increase with the aging population. Nurses and care workers in these settings face various challenges in providing end-of-life care, and interventions for quality end-of-life care may be useful. This feasibility study aims to explore the preliminary effect and acceptability of an intervention named the EOL Care Tool to improve end-of-life care in long-term-care facilities. We conducted a single-arm quasi-experimental study using mixed methods. This tool consisted of multiple components: professionalized lectures, newly developed structured documents, regular conferences regarding end-of-life care, and educational support from administrators. Twenty-four nurses and fifty-five care workers employed in a long-term care facility participated. For nurses, improvement in attitudes toward end-of-life care (p < 0.05) and interdisciplinary collaboration (p < 0.05) were shown quantitatively. Regarding acceptability, nurses and care workers evaluated the tool positively except for the difficulty of using the new documents. However, qualitative results showed that care workers felt the reluctance to address the work regarding end-of-life care. Therefore, a good preliminary effect and acceptability for nurses were indicated, while acceptability for care workers was only moderate. Revision to address the mentioned issues and evaluation of the revised tool with a more robust research design are required.

[Concept analysis of "Gojo" (mutual help)].

Objective　The purpose of this study is to redefine "Gojo" (mutual help) among residents and explore measures to develop it Gojo in the integrated community care system. In 2000, long-term care insurance accelerated Japan's movement toward an aging society, thus increasing the importance of Gojo. This study aims to clarify the conceptual definition it has come to acquire in recent years and explore ways it can be developed in comprehensive community systems.Methodology　Rodger's evolutionary concept analysis was utilized in the study. A keyword research was done using the term "Gojo" in the Japan Medical Abstracts Society (Ichushi Web) and CiNii Articles databases. The search period was from 2000 to 2016 (search date: August 30, 2016) and the database search formula was set to "Gojo/TA". Thirty documents were selected through random sampling and a total of 32 documents were selected for analysis, including landmark documents. A qualitative analysis was conducted on three frameworks: attributes (i.e., characteristics of Gojo), antecedents (i.e., factors affecting Gojo), and consequences (i.e., expected results for Gojo). These three frameworks represent how Gojo is used, the events occurring before it, and the events resulting from it, respectively.Results　The characteristics of Gojo were found to include "experiences of empathy toward residents' daily need for support," "awareness about the residents' efforts to support each other," and "interaction among residents who support other's daily needs." The factors affecting Gojo were identified to be "the need for daily life support beyond what self-help, social solidarity care, and governmental care can provide"; "interchange among residents"; "sharing needs for daily life support among residents"; and "a resident-led public system that promotes mutual support." Gojo's expected results were "a solution for residents' needs of daily support"; "promotion of self-help awareness"; "providing them with a role to enhance their purpose in life"; and "encouraging exchanges and relations between them."Conclusion　Gojo was defined as "the interaction between local residents who support their daily needs, have an empathic experience of the need for daily life support, and have the desire to support each other." In addition, the following points were suggested as measures necessary to expand Gojo. The residents must have sympathy for other residents who need daily life support, understand the benefits of supporting each other, and have a public support system, even if Gojo is led by the residents.

Efficacy of a Community Health Worker-Based Intervention in Improving Dietary Habits Among Community-Dwelling Older People: A Controlled, Crossover Trial in Japan.

Background. Community health workers (CHWs), often called "health promotion volunteers" in Japan, are individuals who act as a natural helping resource in the community. Aim. This study tested the efficacy of a CHW-based intervention to improve dietary habits among community-dwelling older people in Japan, using a controlled, crossover design. Method. Seventy-eight people aged 65 to 74 years with poor dietary variety living in four administrative districts in Hikone City (Shiga Prefecture, Japan) were nonrandomly allocated to an immediate-intervened group (IIG; n = 41) or a delayed-intervened group (DIG; n = 37). Participants joined a biweekly, four-session program (120 minutes/session), comprising "CHW drama-style lectures," "group discussion among participants and CHWs," "tasting of dishes," and "take-home practical activities." For the initial 2-month period, the IIG received the intervention and the DIG did not. The groups were crossed over for the subsequent 2-month period. The primary outcome measure was participants' dietary variety score (score range: 0-10). Results. The dietary variety score in the IIG significantly increased in the initial 2-month period compared with the DIG (effect size 1.60 points; 95% confidence interval: 0.75, 2.45). The intervention had a similar effect in the DIG in the subsequent 2-month period. Moreover, an analysis within the IIG showed that the intervention effects persisted for at least 2 months after the intervention. Conclusions. The CHW-based intervention improved dietary habits among older people. Our findings provide evidence that a CHW-based natural helping approach is a possible solution to promote healthy aging in the community.

[Characteristics of older people willing to offer lifestyle support to other community members living in rural areas with heavy snowfall].

Objective　The increasing aging population has increased the number of older people who need lifestyle support because of their declining mental and physical health. In recent years, it has become necessary to increase the number of residents who can provide lifestyle support. It is highly expected that older people, as local residents, will be keen to offer lifestyle support. This study identified the characteristics of older people willing to offer lifestyle support to other members of the community living in rural areas with heavy snowfall.Methods　We surveyed 801 people, aged 65 years and above, who lived in Yoshijima, Kawanishi town, Yamagata Prefecture, and were not certified in nursing care levels 1-5. A questionnaire was distributed and collected by the president of the neighborhood association and the head of the neighboring group. Data were collected from June to July 2018. The survey included items on basic attributes, health status, social relations with neighbors, and willingness to offer lifestyle support (eight types). A logistic regression analysis was conducted for each support type, with basic attributes, health status, and social relations with neighbors as independent variables and willingness to offer lifestyle support as the dependent variable.Results　We analyzed the data of 586 participants (73.2% valid responses) and found that women were interested in "being a talking partner/consultant in cases of trouble," "helping with meal preparation/cleaning and laundry," and "inviting their neighbors to gatherings and events." However, they were uninterested in "performing outside work such as gardening or fieldwork" and "snow shoveling and removal." People who felt they were affluent were eager to perform "pick-ups and hospital visits," and the higher educated were more interested in "being a talking partner/consultant in cases of trouble" and "helping with meal preparation/cleaning and laundry." Those involved in highly instrumental activities were interested in "monitoring/safety confirmation," "inviting their neighbors to gatherings and events," "accompanying their neighbors for shopping or serving as a substitute," and "pick-up and hospital visits." Further, except "helping with meal preparation/cleaning and laundry" and "performing outside work such as gardening or fieldwork," people with close relationships with their neighbors were significantly more willing to offer support.Conclusion　The characteristics of older people willing to support others depended on the type of lifestyle support required. This finding could help in the recruitment and facilitation of older people willing to offer lifestyle support.

[Characteristics and challenges of health promotion volunteer organizations in Japan: Findings from a national municipality survey].

Objective　Various types of health promotion organizations exist in Japan, including volunteer organizations that promote healthy diets, health improvement, and maternal and child health. Health promotion volunteers, trained and recruited by municipalities, provide counseling and education on various health concerns to community members. A previous study on the effect of these activities and the organizational challenges demonstrated a decrease in the number of volunteer members. The present study aimed to identify the organizational characteristics and challenges of health promotion volunteer work in Japan to gain insight into volunteer recruitment and organizational management.Methods　A questionnaire was sent to 1,873 Japanese municipalities via e-mail or postal mail (excluding Tokyo's 23 wards). For cities of cabinet order, a questionnaire was sent to each borough in the municipality. Data were collected from February to March 2017. The survey was used to collect data on four types of health promotion volunteer organizations: healthy diet (organizations of volunteers who were shokuseikatsu kaizen suishinin), health improvement (organizations of volunteers who were kenkozukuri suishinin), and two types promoting maternal and child health (organizations of volunteers who were boshihoken suishinin and aiikuhan). We asked about the presence or absence of the organization type, year of establishment, number of members, the largest age group, recruitment methods, etc. Twelve organizational challenges were measured with a six-item Likert scale (from 1="strongly agree" to 6="strongly disagree"). Proportions of active members in the volunteer organization ranged from 0% to 10%.Results　Eight hundred eight municipalities responded to the survey (valid responses: 805, valid response rate: 43.1%). The presence or absence of the four types of volunteer organizations differed among the municipalities. The most common type was organizations of volunteers who were shokuseikatsu kaizen suishinin (84.7% municipalities), followed by kenkozukuri suishinin (64.3%), boshihoken suishinin (26.4%), and aiikuhan (10.1%). The total ratio of responses of "strongly agree," "agree," and "somewhat agree" about the organizational challenges, including "The organization cannot find new members easily" and "The participants are always the same people," was commonly more than 50% for the four types of volunteer organizations. The challenges, including "Many do not enjoy what they do," "For many volunteers, participation is limited due to work and family obligations," and "The goal of the activities is not widely shared among volunteers," were significantly correlated to the proportion of active members in the volunteer organization for all four types of organizations.Conclusion　This study revealed that organizational characteristics differed among the four types of health promotion volunteer organizations; however, many of the organizational challenges were found to be common throughout Japanese municipalities.

[Development and effectiveness of care preventive supporter training programs based on a literature review].

Objective　Many preventive care supporter (e.g. kaigo-yobo supporter) training programs, conducted to train community residents, are developed by municipalities. However, it is not necessary that only municipalities can train people effectively or efficiently. In this paper, we initially reviewed the relevant literature and clarified the definitions of concepts like "program contents" and "evaluation indicators," while also planning our own training programs. Later, we developed a program based on the review and examined the results.Methods　The literature of the training program was examined, and the training program was developed based on the result. Four researchers and three public health nurses from a community general support center, in the Otsuchi Town of Iwate Prefecture, developed a training program from June to September 2017. The training program developed was then conducted from October to November 2017. To evaluate the participants' satisfaction with the program, a self-report survey was conducted. To evaluate the outcomes of the program, we measured their degree of comprehension of their community's challenges, before and after the program.Results　The training program was divided into two parts following the literature review. In the first part, the content of the supporters' activities following the program was determined (Type A), and, in the second, the same content was evaluated by the participants within the program (Type B). Type A consisted of various aspects including both concrete knowledge and skills needed to conduct care preventiveactivities after the program. In Type B, there were many aspects-including both lectures and exercises-that aimed to increase the participants' awareness of community challenges, as well as inspection to learn about pioneering activities which helped them consider concrete care preventive activities following the program. In Otsuchi Town, we found it to be imperative for participants to consider how to respond to various situations and accordingly plan the training program for use in Type B. To evaluate the results, 12 participants were analyzed. Participants included two men and ten women, with an average age of 71.4±10.0 years [range: 53-88]. Comprehension levels of community challenges (3.1→4.1, P=0.046), as well as the confidence to actively involve themselves in their own preventive care strategies (3.4→4.0, P=0.035), significantly increased after involvement in the program. However, their confidence to work for community preventive care support groups (3.1→3.5, P=0.227) did not increase significantly.Conclusion　We clarified certain viewpoints, such as the purpose, content, and evaluation indices of community care training programs, by reviewing the relevant literature. Based on the discovered viewpoints, we were then able to obtain certain results through implementing our own training programs, thereby significantly increasing participant comprehension and confidence levels.

[Factors related to support provided by preschool personnel for parents rearing children with special needs: Focus on communicating about the child's developmental problems].

Objectives　Developmental disorders can hinder the acquisition of cognitive function, verbal ability, gross motor skills, and social skills. Therefore, it is necessary to detect them as soon as possible and to consider methods of providing support. Under these circumstances, preschool teachers are responsible for facilitating the support system. This study aimed to describe and classify the support provided by preschool personnel to parents of children with special needs, and to consider the measures necessary to promote support for such parents.Methods　Self-administered questionnaires were distributed to authorized preschool principals and teachers. The questionnaire for principals addressed facility factors within the preschool support system, and that for preschool teachers addressed the teaching factors related to their knowledge and attitude, collaboration among those inside and outside the facility, and support for parents of children with special needs. In addition, we examined the status of support provided to parents for each of the children with special needs picked up by a preschool teacher. To investigate the factors related to the implementation of support to parents, we conducted a multiple logistic regression analysis with the facility and preschool teaching factors as independent variables, and the presence or absence of preschool teachers' support for parents from as a dependent variable.Results　Overall, 10.8% of the children in the surveyed preschools had special needs. Among the surveyed principals and teachers, 73.4% responded that they provided support to parents by "developing a healthy relationship," while 39.5% reported that they provided support by "communicating about the child's developmental problems." In the generalized regression analysis on 535 children with special needs excluding missing values, factors associated with "communicating about the child's developmental problems" were "reflecting on the support that was offered in the teacher-parent conference," "collaborating with other professional staff to a high degree," and "being confident in providing support to parents."Conclusion　This study revealed factors related to providing support for parents of children of concern. The findings suggested that, to promote the provision of support for parents and to establish an early support system for children with developmental disorders, it is necessary to examine ways to conduct a support conference to review actions of preschool teachers retrospectively and to strengthen cooperation with other institutions. It might be effective to solve problems related to developmental disorders at the preschool level through the Community Association for Supporting Developmental Disorders.

Efficacy of a training program designed to help address challenges faced by health promotion volunteers.

Objective　To evaluate the effectiveness of a training program designed to address the following three challenges facing health promotion volunteers: lack of new volunteers, short tenure of volunteering, and failure to build a collaborative relationship with other civic organizations.Methods　Thirty-eight volunteer leaders representing 36 school districts (one from each district and two additional leaders) from southern parts of Shiga Prefecture participated in the training program. Four training sessions were conducted between July 2012 and January 2013. Each session lasted for 2 hours. The program included a lecture, group work, and role playing, all of which centered on the challenges experienced by the volunteers and possible solutions. Those who participated constituted the "training group," and other volunteers in the same area of Shiga, who did not take part in the program, made up the "non-training group." A third, control group consisted of health promotion volunteers based in City A, located outside the areas where the training occurred. To compare the three groups, we collected data before and after the training. The main evaluation index comprised the following three survey items: having confidence in recruiting new volunteers, having confidence in overcoming the difficulties or discouragement to continue to volunteer, and having confidence in explaining their activities to other local organizations to earn their cooperation. These questions were asked in a self-administered questionnaire using a 6-point Likert scale (1: strongly disagree, 6: strongly agree).Results　The data were compared among the training group (28 out of the 38 participants completed the survey), non-training group (n=293), and control group (n=107). On the question about recruiting new volunteers, the training group's mean score increased from 2.9 (standard deviation (SD)=1.3) to 3.3 (SD=1.0) following the training, and the improvement relative to the other two groups was statistically significant (P=0.008 for training vs. non-training, P<0.001 for training vs. control). On the question related to overcoming challenges and continuing volunteering, the training group's mean score went up from 3.3 (SD=1.1) to 3.5 (SD=0.9). The change was statistically significant compared to the non-training group (P=0.033), but not compared to the control group (P=0.401). No statistically significant change was found for the cooperation variable.Conclusion　Overall, this training program appears to be effective in addressing the challenges that health promotion volunteer organizations face.

Cultural Capital: A Concept Analysis.

OBJECTIVE: Harnessing community assets may help public health nurses address health inequalities. Cultural factor is one such asset, which is assumed to be capital in a community. Cultural capital is a key concept for understanding the causes of public health issues. This paper provided an in-depth analysis of "cultural capital" as a concept. DESIGN AND SAMPLE: Rodgers' evolutionary methodology was used for concept analysis. Forty-two studies published in English between 1998 and 2015 were retrieved from MEDLINE by searching for "cultural capital" in the title field. RESULTS: Antecedents of cultural capital included "educational environment," "belongingness in one's social group," "existing health/social inequalities," and "daily behavior." Cultural capital's identified attributes were "social cultivation," "reproductive rubric," "practical knowledge," and "autogenic ability." Cultural capital's consequences were "improving productivity," "reducing health/social inequality," and "enhancing well-being." CONCLUSIONS: Cultural capital is defined as capital characterized by cultivation, rubric, knowledge, and ability. These aspects of cultural capital are typically autogenic, and accumulate and reproduce through lifelong community membership. Cultural capital reduces inequality and ultimately enhances the well-being of individuals and the community through bonding, bridging, and linking economic and social capital.

Association between Municipal Health Promotion Volunteers' Health Literacy and Their Level of Outreach Activities in Japan.

OBJECTIVES: To explore the association between health literacy and levels of three types of core activities among health promotion volunteers (developing a healthy lifestyle, outreach to family, and outreach to community members). STUDY DESIGN: A cross-sectional, anonymous, self-administered postal survey of registered health promotion volunteers in the Konan area in Shiga Prefecture in Japan, conducted in January 2010. The study sample was 575 registered health promotion volunteers. METHODS: The survey collected data on health literacy, gender, age, education, self-rated health, perceptions about the volunteer organization, and perceptions of recognition in the community. The level of engagement in health promotion activities was measured by the extent to which the participants engaged in seven healthy behaviors and promoted them to family members and the community. The authors compared the health literacy level and other characteristics of the participants by core health promotion activities, using a chi-squared test, to examine the associations between demographic and other variables and the three core activities (healthy lifestyle, outreach to family, and outreach to community).Logistic regression analysis was conducted to examine the association between the degree to which the volunteers engaged in core activities ("healthy lifestyle," "outreach to family," "outreach to community") and the levels of health literacy (low, medium, high) among health promotion volunteers, controlling for the effects of age, gender, health condition, education which may also have an impact on volunteers' outreach activities. RESULTS: Four hundred and fifty-four questionnaires were returned, a 79.0% response rate. Excluding 16 cases with missing values on health literacy or the degree of health promotion activities, 438 research subjects were included in the analysis (valid response rate: 76.2%). Health literacy and a few demographic and other characteristics of the volunteers were associated with the three core health promotion activities. In bivariate analyses, active participation in the core activities was more prevalent among older volunteers (p<0.001 for all three activities). Self-rated health condition was associated with both outreach to family (p = 0.018) and community (p = 0.046). Years of experience as volunteer and perception of being recognized in the community also had statistically significant association with outreach to the community (p<0.001). In multiple logistic regression, those with higher level of health literacy were more likely than others to actively engage in outreach to family (OR = 1.70, 95% CI 1.03 to 2.80; OR = 1.76, 95%CI 1.04 to 3.00 for medium and high, respectively) and outreach to community (OR = 2.26, 95%CI 1.34 to 3.83; OR = 2.61 95%CI 1.49 to 4.58 for medium and high, respectively). Perception of being recognized in the community also had a statistically significant and positive impact on outreach to the community (OR = 1.52, 95%CI 1.17 to 1.99). CONCLUSIONS: Volunteers with higher health literacy were more likely to actively engage in outreach to family and outreach to community. Providing educational programs to improve volunteers' health literacy may facilitate their work.

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.

Number of papers published in English from the nursing departments of 42 national universities in Japan in the past ten years.

BACKGROUND: In Japan, the departments of nursing were established by 2004, and graduate school programs for master's degree were established by 2008, in 42 national universities. With these changes, a more academic mission has been pursued, and the need for writing papers in English has increased. AIM: To investigate the numbers of papers published in English from the nursing departments of national universities in Japan over the past ten years. METHODS: The lists of teachers who have nursing licenses in the departments of nursing in the 42 national universities (n=2292) were obtained from the Japan Association of Nursing Programs in Universities. The number of papers published in English by these teachers from 2004 to 2013 was counted using the SCOPUS database. RESULTS: The average number of total papers, in which at least one of the authors was a nursing teacher, and first-authored papers, in which the first author was a nursing teacher, were 211.4 and 69.9 per year, respectively; both increased approximately two-fold during the past ten years. The means and standard deviations of the number of total papers and first-authored papers were 50.3±63.8 (range: 1-382) and 18.3±23.4 (range: 0-147) according to universities, and 1.39±5.84 (range: 0-140) and 0.33±1.28 (range: 0-21) according to teachers, respectively. When journals with the highest number of papers were analyzed, 12 of the top 20 (total papers) and 12 of the top 16 (first-authored papers) were in journals whose editorial offices are in Japan. CONCLUSION: The number of papers published in English has increased over the past ten years, varied markedly depending on the universities and teachers, and many papers were published in Japanese journals. To our knowledge, this is the first report anywhere to determine the average number of nursing papers "per teacher" in a specific population.

The effect of skill mix in non-nursing assistants on work engagements among home visiting nurses in Japan.

AIM: This study evaluated the effect of a skill-mix programme intervention on work engagement in home visiting nurses. BACKGROUND: A skill-mix programme in which home visiting nurses are assisted by non-nursing workers is assumed to foster home visiting nurses' work engagement. METHOD: Pre- and post-intervention evaluations of work engagement were conducted using self-administered questionnaires. A skill-mix programme was introduced in the intervention group of home visiting nurses. After 6 months, their pre- and post-intervention work engagement ratings were compared with those of a control group. RESULT: Baseline questionnaires were returned by 174 home visiting nurses (44 in the intervention group, 130 in the control group). Post-intervention questionnaires were returned by 38 and 97 home visiting nurses from each group. The intervention group's average work engagement scores were 2.2 at baseline and 2.3 at post-intervention; the control group's were 3.3 and 2.6. Generalised linear regression showed significant between-group differences in score changes. CONCLUSION: The skill-mix programme might foster home visiting nurses' work engagement by improving the quality of care for each client. Future research is needed to explain the exact mechanisms that underlie its effectiveness. IMPLICATIONS FOR NURSING MANAGEMENT: In order to improve the efficiency of services provided by home visiting nurses and foster their work engagement, skill-mix programmes might be beneficial.