Predictors of parenting difficulties at the 18-month health checkups: A retrospective study using administrative data from infant health checkups.

OBJECTIVE: This study aimed to identify predictors of parenting difficulties at 18 months from the results of the 4-, 6-7-, and 9-10-month infant health checkups among caregivers who had not experienced difficulties at 4 months. DESIGN AND SAMPLES: This retrospective study used data from infant health checkups conducted in a city in Tokyo from November 2019 to October 2021. The participants were caregiver-child dyads of children who had undergone four checkups. Low birthweight, preterm, and multiple birth infants, and caregivers who experienced difficulties at 4 months were excluded. MEASUREMENTS: Data included caregiver, child-rearing environment, and child factors at the 4-, 6-7-, and 9-10-month checkups and caregivers' self-reported parenting difficulties at the 18-month checkup. RESULTS: Of the 555 caregivers, 48 (8.6%) experienced parenting difficulties at 18 months. Logistic regression analyses showed that mothers' physical condition (4 months), children being male, abnormal child growth (4 months), less than 10th percentile for children's height (6-7 and 9-10 months), and abnormal examination results (6-7 months) were significantly associated with parenting difficulties at 18 months. CONCLUSIONS: To prevent child abuse, public health nurses should consider the identified factors to detect and support caregivers with emerging parenting difficulties.

Effectiveness of a web-based learning program for promoting local healthcare planning competencies.

OBJECTIVE: To determine the effectiveness of a web-based educational program regarding local healthcare planning by public health nurses (PHNs) in Japan. DESIGN: A single-blind randomized controlled trial. SAMPLE: Full-time PHNs working for local governments across Japan. MEASUREMENTS: The primary outcome was nurses' self-perception of competencies in public health policy. The secondary outcome was self-perception of knowledge, skills, and perspectives regarding local healthcare planning. We analyzed intergroup differences using the intention-to-treat principle and the Mann-Whitney U-test. INTERVENTION: The intervention group received six web-based learning modules including substantial knowledge and skills regarding local healthcare planning based on the analysis, design, development, implementation, and evaluation model and adult learning theory. RESULTS: Totally, 273 PHNs registered, and 38 were excluded without completing the baseline survey; 235 were randomly allocated to either the intervention (n = 118) or control (n = 117) groups. Sixty-four participants in the intervention group completed the program. Over 70% of the participants lacked opportunities to learn about local healthcare planning. The intervention group showed significant improvement in self-perception of competencies, knowledge, and skills regarding local healthcare planning, except for items related to evaluation. CONCLUSIONS: The web-based learning program effectively improved participants' self-perception of competencies in local healthcare planning.

Mothers susceptible to child maltreatment and requiring public health nurses' continuous support.

OBJECTIVE: This study aimed to identify the characteristics of mothers who are at a high risk for future child maltreatment and therefore, require continuous support from public health nurses (PHNs) to prevent child maltreatment and those who do not require it. DESIGN AND SAMPLES: This retrospective cross-sectional study included women who were registered in 2018 for being at risk for future child maltreatment and required help with childrearing in City A within the Tokyo metropolis. MEASUREMENTS: Public health nurses registered data pertaining to each mother, including demographic data, family-related variables, assessment by PHNs, use of maternal and child healthcare services, and continuity of support from PHNs. RESULTS: Of the 206 cases, the discontinued group-comprising those who no longer needed PHNs' support-included 83 cases (40.3%) and the continuing group-comprising those needed continuing support-included 123 cases (59.7%). Logistic regression analysis showed that those with marital conflicts, maternal mental instability, lack of parenting skills, and not moving out of the city were more likely to require continuous PHNs' support. CONCLUSIONS: By identifying these factors, PHNs can identify new mothers who need continuous support and provide more concentrated care for them. Thus, support from PHNs can help prevent child maltreatment.

Factors associated with the utilization of community assessment models among Japanese nurses.

OBJECTIVES: This study aimed to identify factors related to the practical utilization of community health needs assessment (CHNA) models that public health nurses (PHNs) learned in their fundamental education. DESIGN: A nationwide questionnaire survey was conducted via postal mail. SAMPLE: We randomly selected 630 public health institutes in Japan. The participants were 3397 full-time novice and mid-level PHNs. MEASUREMENTS: The questionnaire included the participants' basic personal information, six items regarding the perception of CHNA with a 4-point Likert scale, learned models in their undergraduate education, their utilization in practical settings, and the reasons for their answer in narrative form. RESULTS: There were 951 valid responses. The results of logistic regression showed that the significant positively factors with model utilization were perception of CHNA as "not troublesome" or "not impossible as they learned," continuing education with 5 years of experience, and identification of the learned model in continuing education. Furthermore, the results of text mining showed the reasons for non-utilization of the model included being "busy" and having a lack of "opportunity." CONCLUSIONS: This study showed the associated factors with rare utilization of a learned model for PHNs. These findings may suggest improvement of continuing education and development of an appropriate assessment model.

Confusions and responses of managerial public health nurses during the COVID-19 pandemic in Japan.

OBJECTIVE: This study aimed to elucidate the experiences of public health nurses (PHNs) in Japan during the first wave of COVID-19. DESIGN AND SAMPLE: Twelve PHNs in charge of responding to COVID-19 in X-city within Tokyo metropolis in Japan participated in this case study. MEASUREMENTS: Data were collected through self-administered questionnaires and semi-structured interviews on PHNs' experiences from January 2020 to May 2020. RESULTS: Initially, only infectious disease control division (IDCD) PHNs experienced confusion due to the rapidly increased workload. Managerial PHNs attempted to explain the need for a dispatch system for the IDCD, using available statistical data from other managerial members, within one's maximum understanding of this unprecedented situation. Without having a clear and forward-looking understanding regarding the purpose and reasons for dispatching, some dispatched PHNs had concerns and frustrations; they did not view the COVID-19 pandemic as a disaster. In the never-ending, exhausting work, PHNs managed to modify the provision of conventional services to residents. CONCLUSIONS: Despite experiencing confusion, PHNs worked to continuously provide community services, re-considering the meaning of public health nursing. Prioritizing the work and shifting tasks to other professionals at an early stage of the pandemic may prevent organizational dysfunction.

Prefectural public health nurses' support in human resource development of municipal public health nurses in Japan.

Objective　This study aimed to explore the support extended by prefectural public health nurses (PHNs) toward the human resource development (HRD) of municipal PHNs in Japan.Methods　We performed a qualitative descriptive study involving nine prefectural PHNs from April 2019 to May 2020. The data were collected through semi-structured interviews using an interview guide, described qualitatively, coded, and then categorized.Results　Five categories were extracted. "Clarifying the needs and problems related to HRD and daily PHN activities in the municipalities," "Creating an environment where all municipal PHNs have equal opportunities for off-the-job training," and "Helping municipal PHNs recognize the meaning of practice and develop an evaluation perspective" were extracted from the prefectural government PHNs and prefectural health center (HC) PHNs. "Clarifying problems and future prospects to encourage the growth of PHNs" and "Creating an environment where the significance and value of the activities of PHNs are recognized within the organization and HRD can easily take place" were extracted from the HC PHNs.Conclusion　Much of the HRD support provided by the prefectural PHNs to the municipal PHNs was analogous to the PHN activities provided to the community and residents. To promote HRD effectively, prefectural PHNs should apply their individual care skills to the HRD of municipal PHNs.

Self-reported competences of public health nurses for developing needs-oriented local healthcare plans: A nationwide cross-sectional survey.

AIM: To identify self-reported competencies of public health nurses for reflecting community healthcare needs in local healthcare plans. DESIGN: We conducted a nationwide cross-sectional survey in Japan from October 7-November 30, 2019. METHODS: We sent 2,185 self-reported questionnaires to public health nurses in Japan who had developed a local healthcare plan since 2013. Self-reported questionnaires included questions regarding demographic data and the reflection of community healthcare needs in local healthcare plans, and the involvement in local healthcare planning. RESULTS: We analysed 1,042 questionnaires: 651 (62.5%) were from public health nurses who reported that they elicited and shared community views to be reflected for purposes of local healthcare planning (the reflecting group), and 391 (37.5%) of the remaining public health nurses who reported that they did not do so (the non-reflecting group). The logistic regression analysis revealed that public health nurses in the reflecting group were more likely to be in a managerial position, have colleagues who played an active role in healthcare planning, conduct a questionnaire survey, engage in group work, participate in a municipal healthcare planning committee with community-dwelling people, and identify the opinions of the professional organizations. CONCLUSIONS: Identifying community healthcare needs through collaboration with community-dwelling people and professional organizations should be essential competencies for public health nurses (the reflecting group) in developing needs-oriented local healthcare plans. IMPACT: Identification of their related competencies for developing a needs-oriented local healthcare plan as an upstream strategy to mitigate the prevalence of health inequities in each community.

Developing sustainable public health care systems for responding to COVID-19 in Japan.

OBJECTIVE: Despite having prevented public health center (PHC) dysfunction in response to COVID-19 during the first wave, public health nurses (PHNs) who play a central role in preventing COVID-19 and supporting community people were unable to share practical knowledge with other PHNs immediately. This report aims to introduce the development of novel sustainable public health care systems with regard to COVID-19 in Japan: task sharing, securing staff, and task shifting. METHODS: A descriptive study. The Japan Ministry of Health, Labour, and Welfare enlisted good practices regarding resource allocation and developing full readiness for sustainable public health care systems in September 2020. RESULTS: Public health center developed systems for office support, infection control, hospital coordination, and outsourced inventory control. To reduce the workload of PHNs, a support team of three to four office workers developed a response manual for residents and a format for telephone consultations regarding COVID-19. Developing an infection control team and web-based system for hospital coordination decreased the workload of PHCs in each community to prepare for the pandemic. CONCLUSION: Public health center should consider managing limited human resources and focus on providing specialized care for COVID-19 patients. Task sharing, securing staff, and task shifting are crucial strategies for developing sustainable public health care systems.

[Factors associated with community collaboration in the implementation phase of the local health-care, medical, and welfare plan].

Objective　The aim of this study was to elucidate the status of health-care, medical, and welfare planning (hereafter, "planning")-in which public health nurses (PHNs) had participated-and the factors associated with community collaboration in the implementation phase. Additionally, suggestions regarding health activities that would contribute to improving the entire community's health level were obtained.Methods　The Plan-Do-Check-Act (PDCA) cycle was the conceptual framework for this study, and the focus was the implementation phase of the plan (i.e., corresponding to the "Do" phase). Survey items were part of the "Plan" phase and identified the extent to which PHNs collaborated with community-dwellers in implementation, their demographics, their participation in the planning process, organizational factors, and the strategies used in the planning phase. The participants were full-time PHNs working in local governments who had participated in the planning process since 2013 (when the guidelines for PHNs' practices were published). A nationwide, cross-sectional survey was conducted in Japan with 2,185 PHNs from 220 regions (36 prefectures, 41 cities with public health centers, and 153 municipalities) who expressed the willingness to participate in this study. A binomial logistic regression analysis was conducted to examine the association between community collaboration and the independent variables.Results　A total of 1,281 answers (a 58.6% response rate) were received. Ultimately, 1,028 (a 47.0% valid response rate) were analyzed; exclusions were 203 for no experience in health care planning since 2013 and 50 with missing values. There were 125 (12.2%) PHNs who answered that they "did not collaborate with the community-dwellers at all," 293 (28.5%) who answered that they "did not collaborate with them much," 482 (46.9%) who replied that they "collaborated with them a little," and 128 (12.4%) who responded that they "collaborated with them a lot." The binomial logistic regression analysis showed that the following were associated with PHNs' collaboration with the community: being in a managerial position, having experience developing a health promotion plan, conducting a questionnaire survey or group work, as well as participating in municipal health planning committees with community-dwellers, utilizing research evidence, identifying target groups, and managing the plan's progress.Conclusion　From the planning phase, PHNs must collaborate with community residents and reflect their voices so that the formulated plan will help resolve medium to long-term issues in the community related to health and life.

Impact of web-based learning for health program planning competency, knowledge and skills among mid-level public health nurses: A randomized controlled trial.

OBJECTIVES: To evaluate the impact of web-based learning modules for health program planning competency, recognition, knowledge and skills among mid-level public health nurses (PHNs). DESIGN: Parallel-group randomized controlled trial. SAMPLE: During 2018, 244 Japanese PHNs were eligible as participants with 5-20 years experiences as a PHN were randomly allocated to the intervention (n = 121) or control group (n = 123). MEASUREMENTS: The outcome was assessed using the Competency Measurement of Creativity for PHNs (CMC) and 26 questions about recognition, knowledge, and skills for health program planning. INTERVENTIONS: Eight web-based modules. RESULTS: No significant differences in CMC scores between the control and intervention groups at base line and post-intervention. By contrast, significant differences in total score of the 26 items of knowledge and skills. In an exploratory analysis, there was a significant difference identified in CMC scores in the demographic of post graduate training in program planning at base line and post-intervention. (p = .034). CONCLUSIONS: The findings suggested that web-based learning with flexibility in terms of time and location would improve competency, skills and knowledge of health program planning among mid-level PHNs.

Effectiveness of an educational program for mid-level Japanese public health nurses to improve program planning competencies: A preliminary randomized control trial.

OBJECTIVE: To evaluate the effectiveness of an education program for mid-level Japanese public health nurses (PHNs) to improve their competencies in program planning, which will fulfill community health needs. DESIGN: Randomized control trial. SAMPLE: During 2017, 103 PHNs with 5-20 years of PHN work experience in Japan were enrolled and randomly allocated to the intervention (n = 51) or control group (n = 52). MEASUREMENTS: The primary outcome measured competency in program planning based on Competency Measurement of Creativity for PHNs (CMC), knowledge, and skills regarding program planning. INTERVENTION: Six web-based learning modules followed by two face-to-face group sessions. RESULTS: The PHN participants averaged about 12 years of experience. In the intervention group, 25 PHNs completed all modules (49.0%). Post intervention, there were no statistically significant differences among any between-group CMC scores. However, the intervention group's CMC 3 score was significantly higher than that of the control group of ≥12 years of experience. Total knowledge and skill scores also improved significantly in the intervention group compared with the control group. CONCLUSIONS: The results suggest that PHNs with ≥12 years of experience are a suitable target of this educational program, and should play a key role in program planning.

[Preparations made and considered by parents of children with mental illness for their children's lives in the community after their own death].

Objectives　To examine how parents of children with mental illness prepare for their children's lives in the community after their own death.Methods　Twenty-two parents living in the Kanto region, who have children with mental illness, were interviewed from December 2016 to February 2017. Through qualitative inductive analysis, codes were identified from the narrative data that showed the preparation of parents and compared their similarities and differences. Similar codes were collected and subcategories and categories were created with increasing abstraction levels. Each category was considered with respect to the purpose and the reason why each preparation was done.Results　Participants were 9 fathers (40.9%) and 13 mothers (59.1%). Their ages were as follows: in their sixties (n=9; 40.9%), seventies (n=10; 45.5%), and eighties (n=3; 13.6%).　Ten categories emerged regarding parental preparation for their children's life after their death: 1) Forecasting their own death and recognizing the limitations of support; 2) Trying to share with their children about their own death; 3) With consideration of after their own death, organizing the necessary information for their children and their own belongings; 4) Consulting with their relatives about the lives of their children and inheritance, and considering the use of the social resources; 5) Trying to secure a residence and living expenses for their children; 6) Connecting with social resources, searching for recovery methods for their children, and their own health maintenance; 7) Stabilizing and recovering disease conditions of their children, supporting to take medication and outpatient visits; 8) Assessing the ability of their children to live considering their independent life; 9) Developing their abilities to live and sociality, and making reliable supporters other than parents; 10) Encouraging to have fun in their children's lives and considering their employment. Parents were preparing to hope their child would cope with difficulties in their lives after their own death, and maintain a stable life in the community by him/herself.Conclusions　The results suggested that parents should recognize the need of an independent life for their children in the community, to promote concrete preparations toward their children living in the community after their own death.

Educational program for middle-level public health nurses to develop new health services regarding community health needs: protocol for a randomized controlled trial.

BACKGROUND: Developing health services is a key strategy for improving the community health provided by public health nurses. However, an effective educational program for improving their skills in planning such services has not been developed. To describe our program and its evaluation protocol for the education of middle-level public health nurses to improve their skills in developing new health services to fulfil community health needs in Japan. METHODS: In this randomized control trial, eligible participants in Japan will be randomly allocated to an intervention group and a control wait-list group. We will provide 8 modules of web-based learning for public health nurses from July to October 2018. To ensure fairness of educational opportunity, the wait-list group will participate in the same program as the intervention group after collection of follow-up data of the intervention group. The primary outcomes will be evaluated using the scale of competency measurement of creativity for public health nurses at baseline, immediately after the intervention. Secondary outcomes will be knowledge and performance regarding program development of public health nurses. DISCUSSION: This study will enable the analysis of the effects of the educational program on public health nurses for improving their competency to develop new health services for fulfilling community health needs and enriching health care systems. TRIAL REGISTRATION: We registered our study protocol to the University hospital Medical Information Network- Clinical Trials Registry approved by International Committee of Medical Journal Editors (No. UMIN000032176, April, 2018).

Difficulties of fathers whose families evacuated voluntarily after the Fukushima nuclear disaster.

The Fukushima nuclear disaster in 2011 resulted in radiation exposure, and many evacuees felt anxious of its health risks. However, little is known about the difficulties faced by fathers whose families evacuated voluntarily. Therefore, the aim of the present case study was to clarify the difficulties and concerns of fathers whose families evacuated voluntarily after the Fukushima nuclear disaster. Eleven fathers in Fukushima were interviewed between 14 December 2014 and 25 February 2015. Four themes emerged: (i) seeking a safe place away from radiation exposure; (ii) burdens of a double life; (iii) feelings of isolation and perceived deterioration of health; and (iv) deciding on whether to continue voluntary evacuation. Fathers were anxious about radiation exposure, similar to mothers, and faced work-family conflicts from the voluntary evacuation of their families, including financial, physical, and mental sacrifice. Half of the fathers did not express their difficulties to others. Our findings identified a new type of conflict between people of a community who did/did not choose voluntary evacuation. Occupational health nurses should understand fathers' feelings of isolation and monitor their health to prevent the development of stress-related diseases.

Characteristics and related factors of Japanese mothers who have faced difficulties with childrearing.

OBJECTIVE: To identify characteristics of mothers who face difficulties with childrearing. DESIGN AND SAMPLE: Cross-sectional study. During 2014, 221 mothers and 248 children living in City A within the Tokyo metropolis were registered as requiring help with childrearing. Nursing records of 205 mothers (92.8%) and their 227 children (91.5%) were available. We excluded 29 mothers and children owing to incomplete data for a final sample of 176 mothers (79.6%) and 198 children (79.8%). MEASURES: Difficulties with childrearing were assessed by self-reported questionnaires at the newborn child's 4-month health checkups. Data on maternal and child variables were collected from nursing records. RESULTS: The "Difficulties group" included 59 mothers (35.4%) and their 70 children. Logistic regression analysis showed that mothers who were aged 40 years or older, who had a total score on the Edinburgh Postnatal Depression Scale of 9 or greater, who used more child-care support services, and who were monitored more frequently by public health nurses had a high risk of facing difficulties with childrearing. CONCLUSIONS: Periodic monitoring by PHNs is a key strategy to improve the impact of the difficulties of childrearing for mothers of yoshien jido and their children.

Caesarean section by maternal age group among singleton deliveries and primiparous Japanese women: a secondary analysis of the WHO Global Survey on Maternal and Perinatal Health.

BACKGROUND: The rising caesarean section rate is an important public health concern that in turn increases maternal and perinatal risks of adverse effects, unnecessary medical consumption, and inequities in worldwide access. The aim of this study was to investigate caesarean section indications by maternal age group and examine the association between age and caesarean section in primiparous Japanese women with singleton births. METHODS: We analyzed the Japanese data of primiparous women with singleton births from the WHO Global Survey on Maternal and Perinatal Health to compare maternal and neonatal characteristics and outcomes between groups with and without caesarean section. Women were divided into 3 maternal age groups (≤29, 30 to 34 and ≥35 years). We performed multivariable logistic-regression analysis to identify characteristics associated with caesarean section. RESULTS: Of the 3245 women with singleton births were included in the Japanese data, 610 women (18.8%) delivered by caesarean section, half of whom (n = 305) were nulliparous. We included singleton nulliparous women (1747 deliveries) in our analysis. The maternal age 35 years old was associated with higher risks for all caesarean section (adjusted odds ratio [AOR] 1.89, 95% CI 1.28-2.78) and emergency antepartum caesarean section (AOR 2.26, 95% CI 1.49-3.40). Intrapartum caesarean section, which is mainly performed for obstetric indications, was not higher among the older maternal age group. CONCLUSION: In Japan, advanced maternal age significantly increased the risk for caesarean section; however, intrapartum caesarean section was not higher risk among the older age group. Management of maternal complications would help to reduce the rate of caesarean sections and associated unnecessary medical consumption.