The relationship between sense of a life worth living and local self-governance: A cross-sectional study

The Association Between Community Participation and Loneliness Among Patients in Rural Community Hospitals: A Cross-Sectional Study

Introduction Loneliness among adults is a critical public health issue, particularly in rural areas where social isolation can be more pronounced. Understanding the factors that influence loneliness can guide the development of effective interventions. This study explores the impact of demographic, health-related, and social participation factors on loneliness among rural Japanese adults, focusing on the role of community participation. Method This cross-sectional study was conducted with rural Japanese adults who regularly visited rural community hospitals. Data were collected on participants' demographic characteristics, health status, and social participation and analyzed using a multivariate logistic regression model to identify factors associated with higher levels of loneliness. The covariates included age, sex, body mass index (BMI), chronic health conditions, and community participation. Results The study found that community participation had a significant negative association with loneliness, with an odds ratio (OR) of 0.46 (p < 0.01), indicating that individuals engaged in community activities were substantially less likely to experience higher levels of loneliness. Higher BMI was associated with lower odds of loneliness (OR = 0.93, p < 0.02), suggesting a protective effect against loneliness. Conclusion The findings highlight the paramount importance of community engagement in mitigating loneliness among rural Japanese adults. The inverse relationship between BMI and loneliness suggests that BMI and social participation influence loneliness. These insights underscore the need for comprehensive interventions that promote community participation and address the multifaceted nature of loneliness. Future research should further explore the mechanisms through which community engagement and BMI impact loneliness to develop targeted strategies for improving the well-being of rural adults.

The revitalization of "Osekkai": How the COVID-19 pandemic has emphasized the importance of Japanese voluntary social work

Coronavirus disease 2019 (COVID-19) has caused worldwide panic, and rural areas are no exception. In Japanese rural areas, many older people live alone and lack access to reliable sources of information. During the pandemic, older adults were initially isolated from their communities because of the recommended social isolation measures, even when there were no cases in rural communities. However, various formal and informal caregivers went beyond their usual roles and tried to reconnect the older rural population with their communities and nurtured their social connections; Japanese community workers mitigated the stress and fear experienced by the rural elderly in the COVID-19 pandemic. Furthermore, this pandemic encouraged rural Japanese customs. One such custom is "Osekkai." The Japanese word Osekkai describes actions that someone considers useful and meaningful to perform for others. Osekkai involves both formal and informal care, and as social gatherings began to disappear, Osekkai allowed individuals to deal with the various social problems created by the pandemic. Conferences based on Osekkai can strengthen rural people's connections and improve their social capital. Activities of rural people that are constructed through Osekkai conferences are not only evidence-based but also based on reliance. This unprecedented pandemic has taught us not only the importance of usual healthcare and precautions against infection but also that nurturing social connection in communities is crucial in the face of social turbulence.

Effectiveness and Challenges in Local Self-Governance: Multifunctional Autonomy in Japan

Community organizing with government support, termed local self-governance (LSG), is a form of policy decentralization for community wellbeing through solutions tailored to local issues. One form of LSG is multifunctional autonomy, in which citizens can comprehensively manage their communities with government support. This study clarified the effect of multifunctional autonomy on healthy life expectancy by assessing related advantages and challenges in rural Japanese communities, using a mixed-methods approach. Disability-free life expectancy from 65 years (DFLE-65) was assessed to compare healthy life expectancies between two rural Japanese cities (with/without multifunctional autonomy). Comparisons revealed better DFLE-65 only among older men in a city with multifunctional autonomy. A cost-effectiveness analysis investigated the relationship between the budget and DFLE-65 change using questionnaire data. Cost-effectiveness analysis of multifunctional autonomy indicated 61,147 yen/DFLE-65. Thematic analysis revealed that multifunctional autonomy created new roles for older men, improving community relationships. However, sustainable multifunctional autonomy in LSG communities may be hindered by a generally aging society, generation gap, and lack of mutual understanding between rural communities and local governments. To ensure the sustainability of multifunctional autonomy, collaborations between local communities and governments and among various generations are critical.