The Seamless Communication on a Rural Island in Japan: A Qualitative Study from the Perspective of Healthcare Professionals

The experiences of community health workers when communicating with refugees about COVID-19 vaccines in Syracuse, NY: A qualitative study

Background

Refugees are among the most health-vulnerable members of society. Despite the importance of vaccination to mitigate the risks associated with COVID-19 infection, ensuring adequate access and uptake of the COVID-19 vaccine remains a pressing concern for refugee populations. Research has suggested that community-oriented approaches and open communication with trusted individuals are essential to address this challenge. Vaccine outreach efforts were performed in Syracuse, NY, by Community Health Workers (CHWs) as trusted refugee community members. This study explored CHWs' experiences during vaccine outreach and perceptions about COVID-19 vaccine hesitancy and acceptance among refugees, including barriers and facilitators to vaccination.

Methods

A qualitative study was performed using thematic analysis following six semi-structured interviews with CHWs.

Results

Four main themes supported by 16 sub-themes were extracted. CHWs described the (1) diverse beliefs and attitudes of refugees by ethnic group, with most having low vaccine acceptance at first. (2) Barriers included contextual barriers, lack of awareness, misinformation, and withdrawal when forced from vaccine mandates. However, CHWs also identified numerous (3) facilitators to vaccination, including the internal processing and eventual vaccine acceptance, supported by external messaging by CHWs and time. Culturally sensitive intervention strategies occurred through (4) CHW team efforts and their provision of reliable information to refugee clients, with openness and over time. The team efforts of CHWs significantly contributed to refugee acceptance and uptake of the COVID-19 vaccine.

Conclusions

This study revealed how the refugee population changed their belief towards the COVID-19 vaccine through trust, time, and reliable information provided by CHWs and describes culturally sensitive strategies for vaccine uptake by refugees. CHWs' reflection on COVID-19 vaccine hesitancy and acceptance among refugees during outreach efforts is an essential perspective when implementing future public health interventions.

Sustainable Involvement of Family Physicians for Improving Help-Seeking Behaviors in Rural Communities: A Thematic Analysis

Introduction Medicine, particularly family medicine, is crucial to community health and well-being. Its impact on sustainable community care is significant, especially in rural settings with unique dynamics. Recent trends highlight the need for collaboration between family physicians and community members to foster effective help-seeking behaviors (HSBs) linked to improved quality of life and self-efficacy in self-management. This study explores rural communities' perceptions of community care and the integration of family physicians into rural healthcare, enhancing its sustainability. Method A thematic analysis based on relativist ontology and constructivist epistemology was employed. The study was conducted in Unnan City, Japan, involving 81 rural community members. Focus group interviews were the primary data collection method. The research team, comprising a family physician, a non-profit organization director, and a medical educator, analyzed the data, ensuring a balanced and unbiased approach. Results Four key themes emerged, such as understanding the burden felt by existing organizations, continuously engaging in meaningful community activities, steady activities matched to the community's pace, and viewing all places as opportunities for exchange and learning. These themes reflect the need for better information sharing, respecting community dynamics, and incorporating family physicians into various community interactions for effective healthcare delivery. Conclusion This study emphasizes the critical role of family physicians in rural healthcare. It identifies the need for meaningful engagement with local communities, adapting healthcare to the rural context, and using various community spaces for health education. The findings advocate for a community-centric healthcare approach, which respects the unique dynamics of rural areas, fostering a sustainable and responsive healthcare system. Future research should include diverse rural settings and quantitative methods for broader applicability and deeper insights.

Relationship between Dysphagia and Home Discharge among Older Patients Receiving Hospital Rehabilitation in Rural Japan: A Retrospective Cohort Study

Dysphagia refers to swallowing difficulty, which impacts patients' quality of life. Dysphagia influences clinical outcomes, including mortality rates and length of hospital stay of older hospitalized patients. Dysphagia may affect the current and future quality of life of these patients. However, its exact impact remains unclear. We aimed to clarify the impact of dysphagia on discharge to home in older patients in a rural rehabilitation unit. We conducted a secondary analysis using data from a retrospective cohort study including patients aged over 65 years who had been discharged from a community hospital rehabilitation unit in rural Japan. Data from the participants had been previously collected from April 2016 to March 2020. The primary outcome was home discharge. The average participant age was 82.1 (standard deviation, 10.8) years; 34.5% were men. Among medical conditions, brain stroke (44.3%) was the most frequent reason for admission; the most frequent orthopedic condition was femoral fracture (42.9%). The presence of dysphagia (odds ratio [OR] = 0.38, 95% confidence interval [CI]: 0.20-0.73), polypharmacy (OR = 0.5, 95% CI: 0.32-0.90), and admission for internal medicine diseases (OR = 0.44, 95% CI: 0.26-0.77) were negatively associated with home discharge. High motor domain scores of the Functional Independence Measure were positively associated with home discharge (OR = 1.07, 95% CI: 1.05-1.08). Dysphagia was negatively associated with home discharge as were polypharmacy and admission for internal medicine diseases and conditions. By clarifying effective interventions through interventional studies, including approaches to managing multimorbidity and polypharmacy through interprofessional collaboration, the health conditions of older patients in rural areas may be improved.

Rebuilding Social Capital through Osekkai Conferences in Rural Communities: A Social Network Analysis

Social prescribing can promote the creation of new relationships, which may then promote the building of social capital in communities. One example of a social prescribing tool in Japan is Osekkai conferences, which increase social participation and mitigate the degree of loneliness in rural communities. A clarification of the changes in social interaction and intensity of connections among people through Osekkai conferences could contribute to better social prescribing in rural communities. This social network study was conducted among people who have participated in an Osekkai conference. The primary outcomes of degrees and centrality were measured as the degree of social capital. The primary outcomes were compared between April and September 2021 and between October 2021 and March 2022. The continuous performance of Osekkai conferences as social prescribing tools led to an increase in conference participation, mainly by middle-aged women in the communities. Based on a social network analysis, the average direct connection with each person did not increase; the network density decreased gradually; the network diameter decreased from 6 to 5. Regarding the node-level statistics, harmonic closeness centrality and eccentricity decreased, and modularity increased. Social prescribing initiatives should focus on improving social capital in communities, which may improve the number and meaningfulness of the collaborations among organizations and indigenous communities.

Elderly care in Nepal: Are existing health and community support systems enough

In Nepal, a few governmental and community-based programmes for elderly care are in place; however, information about successful implementation and overall effectiveness of these programmes is not well understood. In this article, we introduced these programmes and discussed existing programmes’ gaps and implementation problems in light of existing grey and peer-reviewed evidence. A few notable governmental programmes, such as providing monthly allowances, pensions and free health care, have targeted specifically the elderly individuals. Yet, most health care institutions and providers are privately owned and profit-oriented, and there is a general lack of proper governmental health as well as social security systems for the elderly in the country. Generally, Nepalese communities consist of neighbourhood-based and religious-based groups that provide emotional and spiritual support to elderly individuals as well as provide support for health care access when needed. However, the influence that these groups can have on health and social well-being of elderly remains not well understood. Traditional family-based support systems may be feasible only for some families, while for others it could impose financial and psychological burdens. The role of the state is important in the effective implementation of existing programmes as well as in the development and implementation of additional programmes to ensure health and social well-being of elderly individuals. Furthermore, there is a need to establish partnerships with existing community structures and to mobilize them in the implementation of community-based programmes.