Best practice transfer by public health nurses in Japan: actual conditions and related factors.

BACKGROUND: The workload of public health nurses (PHNs) working for local governments has been increasing as health issues become more diverse and complicated. Even amidst the ongoing administrative and fiscal reforms, there is an urgent need to ensure how effectively and efficiently public health nurses can practice in health service development. The objective of this research was to clarify the actual conditions of best practice transfer (BPT) and its related factors. METHODS: An anonymous postal and self-administered questionnaire survey was conducted among PHNs working at 334 sites, including the local government offices and health centers across Japan, and analysed mainly through logistic regression analysis. RESULTS: One hundred eighty-five of the 334 institutions (55.4%) agreed to participate, and of the 966 questionnaire forms distributed, 709 forms (73.4%) were collected, of which 702 responses (72.7%) were valid. Although less than half (43.2%) have experience in BPT in health service development, more than 80% are willing to perform going forward. Significant factors for both the group with experience in BPT and the group with willingness to perform include an organizational culture that promotes BPT, as well as multiple elements of the workplace environment and facilitating factors related to knowledge and learning. The experienced group recognised the needs for criteria to evaluate the adaptability of best practice, while the willing group, to evaluate the quality of practice. CONCLUSIONS: Through a nationwide survey, this research elucidated for the first time the actual conditions of BPT by PHNs in Japan and related factors. The results indicated the importance of developing a system to promote BPT at the workplace level, also highlighted the importance for practitioners and experts, including researchers, to work together to develop practical guidelines to ensure evidence-based practices. Urgent actions are needed for the national and local governments to develop a system to promote BPT from diverse perspectives, building on the findings of this research.

[Development of an action scale to show the necessity of healthcare activities].

OBJECTIVES: In order to promote high-quality healthcare activities, public health professionals such as public health nurses must improve their ability to systematically show health needs based on evidence and to lead decision making of superior officers and facility inhabitants for improved planning. This study developed and investigated its reliability and validity of an action scale to show the necessity of healthcare activities (SNH). METHODS: The items in the SNH were originally selected based on previous studies and refined by researchers; they were subsequently adjusted after a pilot survey. The subjects were full-time public health nurses (PHNs) working at prefectural public health centers or randomly chosen municipal health centers. Questionnaires were distributed by mail. We explained the ethical considerations in writing and those who returned completed questionnaire forms were considered to have given their consent to participate in the study. The study plan was approved by the university Domestic Ethics Committee. RESULTS: Among 1,615 questionnaire recipients, 1,088 (67.4%) responded; of these, 1,035 (64.1%) responses were valid. Nineteen of 20 items were selected based on results of item analysis, and exploratory and confirmatory factor analyses showed that the SNH consisted of four factors: show existence of health needs, show evidence for the necessity of addressing health needs, show actual conditions requiring solution, and show priority for resolution. Cronbach's alpha, an SNH reliability coefficient, was 0.948, and individual factor scores were over 0.85, supporting the internal consistency of SNH. The correlation coefficient between SNH and the three other scales including related concepts was 0.6-0.8, with significant differences between scales, supporting the criterion-related validity of SNH. The score increased with increasing PHN experience and job seniority, which were used as the known-group, with significant differences between the lowest group and the top two groups. CONCLUSION: The results confirmed that SNH is a reliable and valid scale to show the necessity of healthcare activities.

Implementation Degree Assessment Sheet for Health Program in Japan by Customizing CFIR: Development and Validation.

PURPOSE: More than 70% of public health nurses in Japan belong to government agencies, and there is a need for further evidence-based capacity development for program implementation. The purpose of this research was to develop an Implementation Degree Assessment Sheet (IDAS) by customizing the Consolidated Framework for Implementation Research (CFIR) to health programs in Japan. METHODS: The draft IDAS (five domains, 31 constructs) created by customizing the CFIR was refined by the researchers and modified through pre-testing. The survey covered full-time public health nurses (PHNs) affiliated to all prefectures and the cities with health centers of Japan. The survey was conducted as an anonymous, self-administered questionnaire survey by mail. RESULTS: One hundred eighty-five of the 334 institutions (55.4%) agreed to participate in our survey. Of the 966 questionnaire forms distributed, 709 forms (73.4%) were collected, of which 702 responses (72.7%) were valid. No item required consideration of deletion based on the results of item analysis, and our confirmatory factor analysis on model fitness between the five IDAS domains and CFIR showed sufficient fit indices after modification. With regard to reliability, Cronbach's coefficient alpha, a measure of internal consistency, stayed above 0.8 overall. Our verification of stability with the split-half (odd/even) method resulted in a Spearman-Brown reliability coefficient of 0.95. The correlation coefficient between the IDAS scores and the research utilization competency score, used as an external criterion, was 0.51 (p<0.001), supporting the coexistence validity of the criterion-related validity of the IDAS. The significant differences were observed between known-groups, supporting the known-group validity of the IDAS. CONCLUSION: This study developed the IDAS and confirmed constant reliability and validity. Hereafter, it is necessary to promote the required capacity development based on the actual degree of implementation in order to use the IDAS for the competency development of public health nurses and related professions to deliver health programs.