Introduction

  Tuberculosis (TB) has been reported among young foreign-born students enrolled in Japanese-language schools, who developed the disease after arriving in Japan. However, their experiences with TB from the onset of symptoms to the diagnosis remain unclear. This study aimed to clarify the experiences of young foreign-born students from China and Vietnam regarding healthcare support for TB diagnoses in Japan.

Methods

  Semi-structured interviews were conducted with interpreters and Chinese and Vietnamese students in their 20s who were primarily enrolled in Japanese-language schools. Verbatim transcripts were prepared by a translation company, and data were analysed qualitatively to describe their experiences from the onset of symptoms to the diagnosis of TB.

Results

  The study included 10 Japanese-language students aged 20-27 years (five each from China and Vietnam). At the onset of TB, participants faced language and cultural barriers and financial strain related to tuition and living expenses. They became aware of physical symptoms shortly after arriving in Japan. Despite recognising the seriousness of their symptoms, which did not improve with self-medication, they hesitated to seek immediate medical care because of uncertainty about navigating the Japanese healthcare system. This ‘uncertainty about navigating the Japanese healthcare system’ was the turning point for the three processes: the decision to consult a physician due to the exacerbation of symptoms, the decision to consult a physician in one’s home country, and the decision to consult a specialist because the patient had not been cured by a local physician.

Conclusions

  This study highlights significant challenges, including language and cultural barriers, financial issues, and prioritising economic activities over health, impacting the access to health care for TB diagnosis among foreign-born students. These findings indicate the need for support to reduce the risk of TB and delays in medical examination and diagnosis.

Objective

  We investigated lifestyle changes and disease risk factors in Vietnamese workers after migrating to Japan.

Methods

  From January to March 2022, semi-structured interviews were conducted with 15 Vietnamese workers in Japan regarding their daily habits, focusing on diet and environmental changes. Data were analyzed qualitatively.

Results

  Six men and nine women (average age: 25.5 years) participated. Their residence status included Technical Intern Training (nine individuals), Designated Activities (two), and Engineer/Specialist in Humanities/International Services (four). Their periods of stay ranged from six months to eight years. We extracted 31 main categories (and 100 subcategories) from the interviews that indicated lifestyle changes from Vietnam to Japan. These changes included switching to an imbalanced diet, less fruit intake, greater snack intake, lower alcohol intake, and decreased physical activity after moving to Japan. Participants cited busy schedules (and therefore less time) as the primary reason for dietary changes and reduced physical activity in Japan. Additionally, stress levels rose significantly after migration, with some participants attributing that increase to lifestyle changes. Furthermore, despite reporting no major illnesses in Vietnam, health checkups after living in Japan identified disease risk factors, such as weight changes and negative health conditions (e.g., dyslipidemia, hypertension, liver dysfunction, and anemia).

Conclusions

  Our findings suggest that lifestyle changes are related to post-migration abnormalities in health screening outcomes, including weight gain and dyslipidemia. Recognizing and providing early support for these changes are important in preventing the onset or worsening of noncommunicable diseases among migrant workers.

  Positive Deviance (PD) is based on the observation that in every community there are certain individuals or groups whose uncommon behaviors and strategies enable them to find better solutions to problems than their peers, while having access to the same resources and facing similar or worse challenges. Developed in 1990 by Save the Children to improve child nutrition in Vietnam, the PD approach has gained traction among development partners for various international development projects. This paper discusses how the PD approach and the Logical Framework Approach can be integrated in global health projects.

  The PD approach is effective for projects targeting behavior change, such as those aiming to improve nutrition, reduce infant mortality, promote reproductive health, and prevent non-communicable diseases. To integrate PD with the Logical Framework Approach, projects should create a logic model outlining inputs, activities, outputs, outcomes, and impacts. The PD approach should then be incorporated into each stage of this model. An objective that should be achieved through behavior change is defined as Outcome (Project Purpose), and Outputs need to be considered with the governance and the structure of the target societies and organizations as determinant factors for the dissemination of PD practices. Five steps of the PD implementation process, i.e., defining problems, identifying positive deviants, specifying and extracting PD practices, planning and implementing activities, and monitoring and evaluating, can be incorporated in the project as activities. Inputs should emphasize local initiatives, with experts playing supportive roles.

  While an increasing number of development partners for low- and middle-income countries have adopted the PD approach, such initiatives are still rare among Japanese organizations. The case presented demonstrates that even small-scale projects can yield significant results, encouraging Japanese colleagues to learn from this experience and consider how to initiate the challenge of applying the PD approach in future projects.