Purpose : To explore the methods used by public health nurses (PHNs) to provide culturally sensitive health consultations for community residents in rural communities in order to prevent life-style related diseases and to nurture a health oriented culture. Methods : In three rural areas a total of 19 subjects, who have shown changes in habits that are necessary for preventing life-style related diseases after health consultations by 5 PHNs, were enrolled as participants. Participant observation was conducted at health consultation sessions and PHN's interviewed them about their thoughts. Qualitative and inductive analysis was conducted on the following research questions: a) "What cultural themes did PHNs consider in health consultations ?" b) "How did PHNs use those cultural themes in health consultations to enhance behavioral change for individuals including their families and companies, and to spread this amongst community residents ?" Results : PHNs grasped the cultural themes from three aspects; changeable ones, unchanged ones and original ones. At health consultations, PHNs used these cultural themes as follows; to assess how the culture has changed among individuals and community residents' lives, to motivate individuals to change their behavior by stimulating individual's awareness of the risk in culture and by accepting individual ambivalent feelings accompanied by behavioral change, and to propose concrete methods adjusted for the culture to change habits among individuals and community residents' lives. Conclusion : PHNs are required to understand and make use of the culture according to its changeability. By using the above methods, individuals feel comfortable and seek healthy behavior. If individual habits change and such behavior results in positive healthy changes for others, a chain affect of such behavior can be a long-term positive for the community.

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Objective : The purpose of this study was to clarify characteristics between participants and non-participants of prevention program of long-term care in a rural community, and to examine the appropriate support for the non-participants in the future. Methods : Subjects were 47 participants and 47 matched paired non-participants of the program in A community. The unsigned questionnaires consisted of basic demographic characteristics, physical, cognitive, and psychosocial status were conducted to the all subjects. Results : The mean age (SD) was 79.5 (6.8) years old in the participants and 82.0 (6.2) years old in the nonparticipants. The score of Tokyo Metropolitan Institute of Gerontology Index in the nonparticipations group was significantly lower than the participations group (p < 0.001) and the instrumental independence (p = 0.02), intellectual activeness (p < 0.001), and social role (p = 0.07) in the nonparticipations group was lower than the participations group. The instrumental social support in the nonparticipations group was lower than the participations group (p = 0.09) and so on. The major motivation of the participants to join program is to develop a relationships with other persons, to heal their loneliness in their daily life and to prevent their possible dementia. Conclusion : In the non-participants in the elderly of the preventive approach in long term care were suggested to be lower in the intellectual activeness, social support and the frailty of life style than the participants. It was suggested that there might be frailty of the lifestyle and the interpersonal exchange in nonparticipants. The effective approach for the motivation of the program participation in the elderly should be examined in the future.

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Object : Caravanmate workers (CMWs) are nationally registered professionals who are responsible for helping community people understand and improve community life for those with dementia. This study investigated the frequency, types, and effectiveness of their activities by community size. Method : Self-reported anonymous questionnaires were mailed to 1996 CMWs who lived in Hokkaido, Japan, in June 2008. Their activities were analyzed by the population size of the communities in which each CMW was registered. Community sizes were divided into 5-classes. The data was analyzed by χ²test and other statistical methods based on the types of data. Result and Conclusion : A total of 901 valid answers were received and among those were 357(39.6%) care managers and 101(11.2%) public health nurses. Those with previous experience in community activities comprised 64.7% and the rate of CMWs with experience as a lecturer in the community comprised 39.2% . By population size, subjects with outreach experience to communities of 50-100 thousand were significantly more frequent. When asked about their experiences as CMWs, most subjects gave positive responses such as "Learned a lot from these activities" and "Hoping to continue these activities." Whereas CMWs in communities under 10 thousand population reported feeling a greater burden from these activities than those who lived in communities over 10 thousand population. CMWs who worked in communities with a population of 50-100 thousand expressed more satisfaction than others. CMWs who were registered in a city with a population of 300 thousand reported a lower self-evaluation. These findings suggest that the activities of CMWs should be adjusted to the size of the community they are working in.

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This study was a three-year follow-up survey of Instrumental Activity of Daily Living (IADL) in elderly people living in a mountain area with heavy snowfall to investigate the changes in IADL and discuss the factors influencing the changes. Subjects were 90 elderly people aged 65 years or over with care levels less than II living by themselves or with family members of only elderly people in the B Ward of A City who did not have limitations in IADL for all five items in the initial survey in the winter of 2003. An interview survey was conducted for the follow-up by using a questionnaire in the winter of 2006, which was three years after the initial survey. The results showed the percentages of male and female subjects who still maintained IADL for all five items during the follow-up survey of 80.8% and 76.6%, respectively. The percentages were significantly higher in men who changed electric bulbs, cleared snow around the house, and prepared against disaster and in women who shopped for groceries, did laundry, cleaned rooms, bathed, maintained bedclothes, and threw out the garbage. These findings indicated that focusing on the daily activities of the elderly people may allow the early identification of individuals who are likely to require daily support and care at some point.

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Objective : The aim of the present study was to clarify the mental changes perceived by participants of group activities for mothers who are concerned about child-rearing. The effects of the group activities were assessed based on the responses to interviews. Method : In semi-structured interviews, three mothers who had participated in the group activities were questioned regarding items such as "motivation for participation in group activities" and "changes perceived in yourself due to participation in group activities." Results : The three mothers had initially attempted to raise their children following ideals described in child-rearing books. However, when things did not go as planned, they felt anger towards and struck their children. Concerns about this behavior motivated participation in the group activities. The mothers formed trusting relationships with the other group members and public health nurses and, as their sense of security increased, they became able to mention their concerns which in turn relieved their feelings. The mothers perceived changes in them with respect to their ability to accept themselves as they are and their ability to control anger towards their children, which resulted in changes in their attitudes toward child-rearing. Conclusions : By putting themselves the secure environment of the group and discussing their concerns, mothers relieved their stress from child-rearing. Furthermore, they became able to accept themselves. These changes facilitated by group participation were considered to be linked with the development of mother's potential.

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Purpose : The objective was to clarify the incidence of falls in the home environment among the region's elderly women, and to investigate the support for fall prevention. Methods : The study participants were 207 women aged 65 years and over who were attending an educational lecture for the elderly. The survey method involved the use of an anonymous, self-administered questionnaire on each day of the lecture. The questionnaire items included basic attributes, the circumstances of falls, the home environment, physical health and activities of daily living (ADL). Results : Of these subjects, 49 (23.7%) had experienced a fall within the past year. There were 14 (28.5%) who had experienced a fall at home, with a mean age of 75.9 ± 5.7 years, which was higher than the mean age of all members of the group who had falls. The characteristics observed for those who had experienced falls at home were that many had housemates, many suffered from osteoporosis, many had injuries that required a doctor's visit, and in particular two (10.0%) who were in their 80s had bone fractures. Regarding the steps and floor surfaces in the home, there were 9 factors reported by a significantly larger proportion of the "fall group" vs. the "non-fall group," such as "there are steps in the gate and at the front door, and I almost stumble," "the entrance step is high and I lose my balance," "the mat, carpet and kitchen mat are slippery and I stumble easily," "there are electric cords running across the floor." Home environmental factors were the cause of falling for 50.0% of those who had falls in the home. Conclusions : It was shown that having steps in the home is related to falls, and that many persons aged 75 and over suffer from falls in the home. This study suggests the necessity that the preventive nursing care industry should not only be concerned with exercise, but should also incorporate details of improving the housing environment of private homes. In particular, it is necessary to improve the housing environment of private homes by considering how to prevent falls by persons aged 75 and over.

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Objective : The purpose of this study was to clarify how people with impaired glucose tolerance living in a rural area transform their health-related behavior. Methods : We conducted semi-structured interviews with 10 people, all with impaired glucose tolerance, attending community health classes. Modified Grounded Theory Approach was used in data analysis. Results : From interview transcripts a total of 30 concepts related to the process by which participants made changes in health-related behavior were identified, from which 8 categories were extracted : indifference towards one's body ; opportunities for class participation ; opportunities to notice health problems ; maintaining one's willpower ; flexibility through trial and error ; sources of inspiration ; stimulation from one's surroundings ; and becoming accustomed to change. Three categories were considered most important to the behavioral change process : opportunities to notice health problems, maintaining one's willpower, and flexibility through trial and error. The opportunity to notice health problems was considered most important. A cycle was formed by the linking of 3 categories : noticing, consciousness, and action ; noticing was established as the source of the cycle's circulation. Moreover, it was established that actions is changed by the act of becoming accustomed to change, which ensures that actions will continue. Discussion : Noticing problems in health-related behavior is important. In order for the cycle of noticing, consciousness, and action to continue, communication between participants in health classes, as well as periodic opportunities to notice health problems through self-monitoring, can be considered crucial.

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The purpose of this research is to describe the first-year experiences of novice public health nurses, focusing on their interactions with local mothers in the maternal and child health program. The Participants were nine public health nurses having 1 year of experience at their job. Semi-structured interviews to gather data on novice public health nurses' experience were conducted. The first-year experiences of the novice public health nurses were classified into the following nine categories. As novice public health nurses started working in the maternal and child health program, they experienced [confronting the scale of their responsibilities combined with their inexperience]. Simultaneously, in their interactions with the mothers during medical examinations, they experienced [feeling frustrated with their inability to give appropriate advice]. They then began [identifying the knowledge and techniques they need to acquire through their conversations with the mothers], [devoting themselves to supporting the thoughts of the mothers], and [striving to make up for their lack of experience as an aid provider]. By repeatedly making effort and taking action they became capable of [flexibly responding to situations by making decisions based on the characteristics of the mother or their group]. Moreover, some experienced [acquiring a broader general perspective through the maternal and child health program]. After their first year, the novice public health nurses felt that they were [being able to interact with the mothers in line with the support they needed] and were [feeling confident that they will be able to continue interacting with the local residents].

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Objective : To obtain information from which to assess how to support family management of the main caregivers of 19-month-old infants, and how to engender cooperation from their partners. Procedure : We mailed anonymous self-response questionnaires to 743 main caregivers of 18-month-old infants who were given check-ups in "A" City, and included 241 of them in our analysis. Situations such as their own health care and cooperation with their partners, and child abuse potential risk were analyzed with respect to birth ranking, using the χ²test and Kruskal-Wallis test for comparison. Result : We detected a significant difference in the cooperative situation with partners and child abuse potential risk with respect to birth ranking. Rearing the first child engenders a stronger cooperative relationship with a partner than rearing the second and third child which creates significantly weaker attitudes with respect to "depending on power" and "fostering a sense of self-esteem" in child abuse potential risk. As birth ranking degraded, relations with partners were polarized between good and bad. In rearing the third child or later, though we detected a stratum where cooperative relations with partners waned, "the attitude which teach control of desire" in child abuse potential risk was weaker. Conclusion : In order to maintain desirable rearing, it is suggested that we need to continuously bring into view the relationship with partners from the time of rearing the first child and to support the caregiver's own health and the family according to their children's growth.

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Purpose : The purpose of this study is to develop a public health nurses' (PHNs) competency model showing useful abilities and ways of behaving or thinking in building and developing an effective community comprehensive supporting system (CCSS) for local residents' needs. Competency consists of surface knowledge and skill competencies, motives, traits and self-concept as deep competencies, according to the definition of McClelland and Spencer. Method/Results : The study method constituted the making of a competency model tentative plan (study 1) and inspection of the utility of the tentative plan (study 2). Study 1 : Five PHNs with experience in building and developing the CCSS were chosen, and a semistructured interview on the effective events of the CCSS was conducted. The CCSS had five stages namely, preparing and noticing needs, analyzing the present conditions, devising a strategy, action, and evaluating and revising. The competency model tentative plan was made based on surface competencies and deep competencies of the depths of each stage and those relations. Study 2 : Three PHNs who were building the CCSS were chosen, and a semi-structured interview on the tentative plan was conducted. Their way of thinking was activated, they confirmed the effectiveness of a way of thinking and the action, and were able to set their problem. From this, the utility of this model was inspected. Conclusion : This model had the following characteristics. Displaying knowledge and skill competencies was necessary while be realized traits and self-concepts competencies were related and promoting the next stage by developing motives competencies.

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Aim : To investigate the process of creating autonomy among community residents participating in health planning and promotion, through empirical research with community residents. Methods : Semi-structured interviews were conducted on 6 residents who participated in health planning and promotion in A-town, and data collected were analyzed using qualitative, inductive methods. Results : The 4 stages that emerged in the process of autonomy creation among community residents involved in health planning and promotion were "Participating primarily as a representative of one's own organization," "Group formation and emergence of autonomy through discussion," "Testing of autonomy through promotion in one's own organization" and "Experiencing the results of autonomous promotion of the health plan and feeling empowered." Conclusion : In the first stage of participating in health planning and promotion, residents acted as individual representatives of their organizations, but through frank debate and philosophical thinking, they formed a group and began to develop autonomy. In the stage of promoting the health plan, residents' real autonomy was tested. Through philosophical thinking, they formed real autonomy.

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[in Japanese]

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[in Japanese]

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Purpose : The purpose of this study was to clarify some of the key elements required for building collaborative partnerships between public health nurses (PHNs) and the nursing college faculty in order to solve problems in public health nursing practice. Method : Faculty members provided written field notes about collaboration between PHNs and the faculty and the roles of the PHNs and the faculty in A town. Collected data were analyzed in order to identify key elements that lead to collaborative partnerships. Results : The following 8 key elements were identified : 'Recognize activities that are common to both PHNs and the faculty,' 'Examine whether the activity matches the residents' needs,' 'Establish a plan for collaboration with the intention to help both PHNs and the faculty, and put the plan in practice,' 'Commit to improving the situation for both PHNs and the faculty,' 'Review the aims/results of collaboration activities and the activities of the PHNs, and revise the activity plan,' 'Utilize the merits of both PHNs and the faculty,' 'Recognize the meaning of the support and the significance of being a PHN, and share it with others,' and 'Perform care systematically as an opportunity for PHNs to learn.' Conclusion : Although key elements affecting collaboration were identified, future research should investigate other factors that affect collaborative partnerships between PHNs and the faculty.

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[in Japanese]

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Aim : To highlight the current status of obesity prevention among preschool children in Japan and to clarify the future research tasks related to this topic. Methods : A literature search was conducted in the Japanese Central Review of Medicine, NII Scholarly and Academic Information Navigator, and PubMed by using the key words "preschool children," "obesity," and "prevention." Twenty-two research papers published between 2000 and 2009 were selected as the target articles in this study. Results : There are only a few studies that investigate obesity prevention among preschool children. These studies employed various screening methods and diagnostic modalities. The settings in most of these studies were local health centers, but the public health nurses working at these centers did not adequately study the prevention of childhood obesity. The risk factors of obesity among preschool children included lifestyle, parents' attitude, and heredity. Because many of these studies were cross sectional, the relation between cause and effect was not clear. Discussion : The following three measures were required for obesity prevention among preschool children: (1) conducting research to standardize criterion for obesity among preschool children, (2) conducting research to examine opportunities and settings for intervention, and (3) performing cohort studies or randomized clinical trials including the risk factors of childhood obesity pointed out in not only previous Japanese studies but also overseas ones.

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Purpose : The purpose of this study was to explore associated factors with burnout among the workers of Community Comprehensive Support Center (CCSC), focusing on network building of CCSC with informal community organizations (ICO). Methods : A self-check questionnaire survey was conducted to 88 workers of CCSC in a ward, Tokyo, in May 2009. The questionnaire assessed individual factors (such as gender, age and job satisfaction), environmental factors (such as working hours per week, social support and feeling for network building with ICO), and the Maslach Burnout Inventory. Results : A total of 84 questionnaires were analyzed (valid response rate: 95.5%). About 20% of participants had severe burnout. Multiple regression analysis showed that the higher score of emotional exhaustion was associated with more working hours, lower job satisfaction, and feeling more difficulty for network building with ICO. The higher score of depersonalization was associated with lower job satisfaction, less social support from manager, and more feeling more difficulty for network building with ICO. Moreover, the lower score of personal accomplishment was associated with working full-time, lower job satisfaction, and feeling less challenging for network building with ICO. Conclusion : The findings of the study suggested that it would be important for the prevention of burnout in the workers of CCSC to improve the feeling for network building with ICO.

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[in Japanese]

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[in Japanese]

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