Three-year evaluation of a program teaching social determinants of health in community-based medical education: a general inductive approach for qualitative data analysis.

BACKGROUND: Social determinants of health (SDH) are intricately intertwined with various social and economic factors. Reflection is essential for learning about SDH. However, only a few reports have focused on reflection in SDH programs; most were cross-sectional studies. We aimed to longitudinally evaluate a SDH program in a community-based medical education (CBME) curriculum that we introduced in 2018 based on the level of reflection and content on SDH in students' reports. METHODS: Study design: General inductive approach for qualitative data analysis. Education program: A 4-week mandatory clinical clerkship in general medicine and primary care at the University of Tsukuba School of Medicine in Japan was provided to all fifth- and sixth-year medical students. Students underwent a 3-week rotation in community clinics and hospitals in suburban and rural areas of Ibaraki Prefecture. After a lecture on SDH on the first day, students were instructed to prepare a structural case description based on encounters during the curriculum. On the final day, students shared their experiences in a small group session and submitted a report on SDH. The program was continuously improved and faculty development was provided. STUDY PARTICIPANTS: Students who completed the program during October 2018-June 2021. ANALYSIS: Levels of reflection were categorized as reflective, analytical, or descriptive. The content was analyzed based on the Solid Facts framework. RESULTS: We analyzed 118 reports from 2018-19, 101 reports from 2019-20, and 142 reports from 2020-21. There were 2 (1.7%), 6 (5.9%), and 7 (4.8%) reflective reports; 9 (7.6%), 24 (23.8%), and 52 (35.9%) analytical reports; and 36 (30.5%), 48 (47.5%), and 79 (54.5%) descriptive reports, respectively. The others were not evaluable. The number of Solid Facts framework items in reports were 2.0 ± 1.2, 2.6 ± 1.3, and 3.3 ± 1.4, respectively. CONCLUSIONS: Students' understanding of SDH deepened as the SDH program in the CBME curriculum improved. Faculty development might have contributed to the results. Reflective understanding of SDH might require more faculty development and integrated education of social science and medicine.

Gender-Related Differences in Social Participation Among Japanese Elderly Individuals During the COVID-19 Pandemic: A Cross-Sectional Survey.

INTRODUCTION/OBJECTIVES: The health of elderly individuals is known to benefit from maintaining societal involvement and relationships with other people, such as through social participation. We aimed to determine trends in the percentage of Japanese elderly people who engaged in social participation before and during the coronavirus disease 2019 (COVID-19) pandemic in one municipality in Japan, and compared differences in this status by gender. METHODS: We conducted a cross-sectional questionnaire survey. Questionnaires were sent by mail to 3000 people aged 65 to 85 years who were randomly selected by the administrative staff of the city. Participant characteristics (age, gender, working status, residential status) and their economic status, daily physical activity, and social participation status were obtained at 3 time points: (1) before the COVID-19 pandemic in January 2020; (2) immediately prior to the declaration of a state of emergency in April 2020; and (3) in January 2021, 1 year after (1). RESULTS: A total of 1301 people responded to the survey. The mean age was 73.3 (SD 5.5) years, and 690 (53.0%) were women. There were significant gender differences in terms of living alone, employment status, and amount of physical activity. The number of people reporting social participation gradually decreased from 543 respondents (41.7%) at (1) to 319 (24.5%) at (2) and 251 (19.3%) at (3). Women were more likely to demonstrate reduced social participation. CONCLUSIONS: Elderly individuals, particularly women, reported decreased social participation during the pandemic.

Changes in home visit utilization during the COVID-19 pandemic: a multicenter cross-sectional web-based survey.

OBJECTIVE: Home care is one of the essential community health care services; thus, identifying changes of home care utilization before and during the COVID-19 pandemic would be useful for researchers and policymaker to reconsider the home care system, the support needed for home care staff, and the collaborative system with hospitals in the COVID-19 era. We conducted a multicenter cross-sectional web-based anonymous survey of the directors of home visit facilities in Japan in August 2021. RESULTS: A total of 33 participants from 37 facilities responded to the survey. The number of patients dying at home and newly requested home visits increased during the COVID-19 pandemic (74.2%, 71.0%). One possible reason was the restricted visitation of inpatient facilities (93.5%). The underlying disease that the largest number of participants perceived as having increased compared with before the COVID-19 pandemic was cancer (51.6%). There were no significant differences in being in a rural area or the number of doctors in perceived changes in home visit utilization. Our study indicated that the director of home visit facilities thought the number of patients dying at home and newly requested home visits had increased compared with before the COVID-19 pandemic.

Exploration of the impact of the COVID-19 pandemic on the mental health of home health care workers in Japan: a multicenter cross-sectional web-based survey.

BACKGROUND: The COVID-19 pandemic has caused home health care workers (home-HCWs) to experience anxiety. The mental health of home-HCWs and related factors during the COVID-19 pandemic have not been clarified; therefore, we aimed to investigate the status and associated factors of fear of COVID-19 infection, anxiety, and depression among home-HCWs in Japan. METHODS: We conducted a multicenter cross-sectional web-based anonymous survey of home-HCWs in August 2021, during the fifth wave of the pandemic in Japan. We surveyed members of facilities that provided home visit services during the COVID-19 pandemic. We measured the Japanese version of the Fear of COVID-19 scale (FCV-19S-J) and the Hospital Anxiety and Depression scale (HADS) as objective variables, and the Japanese version of the Assessment of Interprofessional Team Collaboration Scale-II (J-AITCS-II) as an explanatory variable. RESULTS: A total of 328 members of 37 facilities responded to the survey, and we ultimately analyzed 311 participants. The most frequent occupation was nurse (32.8%), followed by doctor (24.8%) and medical office staff (18.0%). The mean score of the FCV-19S-J was 16.5 ± 5.0 (7.0 - 31.0), and the prevalences of definitive anxiety and depression were 7.4% and 15.7%, respectively. Multivariate regression analysis revealed that the J-AITCS-II teamwork subscale was significantly negatively associated with FCV-19S-J, HADS-anxiety, and HADS-depression (ß = -0.171, p = 0.004; ß = -0.151, p = 0.012; ß = -0.225, p < 0.001, respectively). Medical office staff showed significant positive associations with FCV-19S-J and HADS-depression (ß = 0.219, p = 0.005; ß = 0.201, p = 0.009, respectively), and medical social workers with HADS-anxiety and HADS-depression (ß = -0.166, p = 0.011; ß = -0.214, p < 0.001, respectively) compared with doctors. The unmet support need for expert lectures on COVID-19 was significantly positively associated with FCV-19S-J (ß = 0.131, p = 0.048), and the unmet support need for support systems for psychological stress and emotional exhaustion was significantly positively associated with HADS-anxiety (ß = 0.141, p = 0.022). CONCLUSIONS: Fear of COVID-19 infection and depression of nurses, medical office staff, and other occupations was significantly higher than those of doctors. These findings suggest that non-physicians were more likely to be fearful and depressed during the COVID-19 pandemic; thus, it is necessary to tailor mental health support based on occupation in the home care setting.

Frailty and social participation in older citizens in Japan during the COVID-19 pandemic.

Background: This study examined the frailty status of older individuals in Japan at 1 year after the onset of the coronavirus disease 2019 (COVID-19) pandemic based on involvement in social activities before and during the pandemic. Methods: This cross-sectional study analyzed citizens aged 65 and 84 who did not require long-term care in January 2021. A self-administered questionnaire was mailed to 3000 citizens in Kitaibaraki City, Japan. The questionnaire included social participation status in January 2020 and January 2021, the Kihon Checklist, working status, and economic status. We classified the respondents into the following groups: Nonparticipating, no participation at either time point; Discontinued, participation only in 2020; and Continued, participation at both time points. We compared the Discontinued and Continued groups in terms of Kihon Checklist items using the t-test. Results: Of 2963 individuals who received the questionnaire, 1307 (44.1%) returned it, and 1047 were analyzed. Of the respondents analyzed, 586 (56.0%) were in the Nonparticipating group, 254 (24.3%) were in the Discontinued group, and 207 (19.8%) were in the Continued group. On the Kihon Checklist, oral function and mood differed significantly between the Discontinued and Continued groups. The proportion of those with impairment in multiple categories of the Kihon Checklist was 12.3% in the Nonparticipating group, 5.5% in the Discontinued group, and 3.4% in the Continued group. Conclusions: Older individuals who continued participating in social activities at 1 year into the COVID-19 pandemic might have a lower risk of frailty in terms of oral function and depressed mood.

Primary care physicians' narratives on COVID-19 responses in Japan: Professional roles evoked under a pandemic.

Background: Within the vague system of primary care and COVID-19 infection control in Japan, we explored how primary care (PC) physicians exhibited adaptive performance in their institutions and communities to cope with the COVID-19 pandemic from January to May 2020. Methods: Narrative analysis conducted by a team of medical professionals and anthropologists. We purposefully selected 10 PC physicians in community-based hospitals and clinics and conducted a total of 17 individual and group interviews. The verbatim transcript data were analyzed using the conceptual framework of adaptive performance. Results: We identified three "phases" of the time period (January-May 2020). In Phase 1, PC physicians initially perceived the disease as a problem unrelated to them. In Phase 2, the Diamond Princess outbreak triggered adaptive performance of the physicians, who began to deal with medical issues related to COVID-19 by using social networking services and applying the collected information to their organization and/or communities. Following this, in Phase 3, the PC physicians' adaptive performance in their own communities and institutions emerged in the face of the pandemic. Reflecting their sensitivity to local context, the PC physicians were seen to exhibit adaptive performance through dealing with context-dependent problems and relationships. Conclusions: PC physicians exhibited adaptive performance in the course of coping with the realities of COVID-19 in shifting phases and in differing localities in the early stages of the pandemic. The trajectories of adaptive performance in later stages of the pandemic remain to be seen.