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To investigate how having a child without a disability is related to maternal mental health and its predictors, we compared mothers of a single child with intellectual disabilities (single-child group, n = 117) and mothers of children with and without intellectual disabilities (multiple-children group, n = 457), in Japan. Compared to the multiple-children group, the single-child group had lower hope and social capital and poorer mental health; furthermore, 42.5% of them had decided not to have another child, despite desiring one. Hope was the strongest predictor of mental health in both groups but was more positively related to mental health in the multiple-children group. The fear of the possibility of the next child having a disability and receiving inadequate support were the obstacles for mothers who had decided not to have another child. Thus, greater support and more opportunities for obtaining adequate information about the implications of having another child may be needed.

Background: Although sense of coherence (SOC) moderates parental stress, the relationship between SOC, parental mental health and physical punishment of children with intellectual disabilities remains uncertain. The present authors describe parental physical punishment towards children with intellectual disabilities and investigate its related demographic characteristics, SOC and parental mental health. Materials and Methods: With the cooperation of Tokyo's 10 special needs schools, the present authors obtained 648 questionnaire responses from parents of children with intellectual disabilities. Results: Of the parents, 69.7% reported having physically punished their children with intellectual disabilities. This was positively associated with parents' younger age, poorer mental health, lower SOC, children's younger age, birth order (firstborns) and disability type (autism/pervasive developmental disorder). Conclusions: This is the first study supporting the relationship between SOC, mental health and physical punishment use among parents of children with intellectual disabilities. It may assist the development of strategies to prevent physical abuse of children with disabilities.

This study examined the relationship between the sense of coherence (SOC), which is conceptually the ability to successfully cope with stress, of Japanese junior high school students and their mothers, and investigated SOC-related factors among the students. We analyzed self-reported data from 134 junior high school students (aged 12–14 years) and their mothers (average age: 45.5 ± 4.1 years), based in an urban area of Japan. We found a weak correlation between the SOC total scores of female students and their mothers; further, few subscales showed weak correlations. However, the SOC of male students was not correlated with that of their mothers, including the three subcomponents that constitute the SOC. The results of multiple regression analysis indicated that the SOC of female students was negatively associated with ASD-related characteristics, sensitivity to evaluation, and avoidant help-seeking style, and positively associated with a sense of belonging to the school. However, male students' SOC showed a negative relationship with excessive response to evaluation and a strong sense of parental control. To improve SOC in adolescents, it is necessary to consider their gender differences and support them, both at home and school. [ABSTRACT FROM AUTHOR]

Personal recovery is a process of developing new meaning and purpose in life beyond the catastrophic effects of mental illness. Benefit finding (BF) is conceptualized as finding positive changes or benefits through experiences in adversity. Sense of coherence (SOC) focuses on how people can stay healthy and maintain well-being, even in adversity. This study aimed to examine the relationships among the initial levels and longitudinal changes in personal recovery, BF, and SOC among people with chronic mental illness in Japan. In this longitudinal study, a two-wave self-report questionnaire survey was conducted for service users aged 20 or older with mental illness using convenience sampling method in 2014 and 2015. We applied the Latent Change Score approach. Model fit was evaluated according to the CFI and RMSEA. Among 373 eligible participants at baseline, valid responses in both T1 and T2 from 195 respondents were included in the study (valid response rate = 52.3%). Among them, 65.6% were male, with average age of 45.6. The model of the three constructs at the two time points had good to reasonable fit to the data. The initial levels and changes in personal recovery, BF, and SOC were significantly and positively related to each other. [ABSTRACT FROM AUTHOR]

Background Although sense of coherence ( SOC) moderates parental stress, the relationship between SOC, parental mental health and physical punishment of children with intellectual disabilities remains uncertain. The present authors describe parental physical punishment towards children with intellectual disabilities and investigate its related demographic characteristics, SOC and parental mental health. Materials and Methods With the cooperation of Tokyo's 10 special needs schools, the present authors obtained 648 questionnaire responses from parents of children with intellectual disabilities. Results Of the parents, 69.7% reported having physically punished their children with intellectual disabilities. This was positively associated with parents' younger age, poorer mental health, lower SOC, children's younger age, birth order (firstborns) and disability type (autism/pervasive developmental disorder). Conclusions This is the first study supporting the relationship between SOC, mental health and physical punishment use among parents of children with intellectual disabilities. It may assist the development of strategies to prevent physical abuse of children with disabilities. [ABSTRACT FROM AUTHOR]

Fibromyalgia (FM) is a controversial disorder with an unknown organic basis, so the legitimacy of the disease is controversial. People with FM struggle to explain their 'invisible' illness and to reconstruct their biographies. This study focuses on the significance of self-help groups (SHGs) in the process of reconstructing biographies of persons with FM. We interviewed 13 individuals with FM who participated in 2 different types of SHGs. Informants suffer from disparities between their severe bodily symptoms and appraisals from others, resulting in self-doubt and existential crisis. These disruptions were partially repaired by receiving a diagnosis, but this provided limited power to explain their 'unreasonable' disruption. Our findings indicate the importance of hearing the life stories of peers which can repair informants' disrupted biographies through the fu-ni-ochiru experience, a form of comprehension of one's illness by which the informant obtains a clear perspective through physical sensation, or full acceptance rather than logical understanding. Thus, our study expands knowledge regarding how people with FM reconstruct their biographies. [ABSTRACT FROM AUTHOR]

Background The present study investigated when and how Japanese people with cleft lip and palate (CL/P) learn that their condition is congenital; the perceived effects of withholding the CL/P diagnosis on patients; and whether the resulting social experience and self-esteem are related. A questionnaire survey was conducted in 71 adults with CL/P recruited through a hospital, a patients' association, and by snowball sampling. Results The participants became aware of their physical difference in childhood, but many reported difficulty in understanding their condition. Participants reported that their families avoided the topic of diagnosis. Participants who understood their condition during childhood rather than in adulthood were significantly more likely to consider this scenario as positive (p < 0.001). Although stigmatising experiences were extremely painful, most patients hid their suffering, making it more difficult to obtain social support. Participants with high self-esteem were more likely to feel that they received adequate support. Conclusions It is important to explain the congenital nature of CL/P sufficiently and early. In addition, openness by the family about the diagnosis, rather than avoidance, may improve patients' self-esteem. Sufficient support from family, health care providers, and significant others is needed for patients to develop adequate self-esteem. [ABSTRACT FROM AUTHOR]

In developed countries, human immunodeficiency virus (HIV) has become a chronic disease. The aims of this study were to clarify the physical, social, and psychological factors affecting Japanese HIV patients in a stable condition and to identify factors related to mental health of employed and unemployed HIV patients. The target subjects were people with HIV infection who were treated as outpatients at core hospitals for acquired immune deficiency syndrome (AIDS) treatment in Japan. A questionnaire including items from the Hospital Anxiety and Depression Scale (HADS) was sent to each medical facility with a request for participation from the HIV-infected outpatients. Responses from 1199 patients were analyzed. Mental health was reportedly better in the employed patients than in the unemployed patients. The unemployed patients were more likely to have resigned from their jobs because of poor health, to have resigned voluntarily, or to have been unfairly dismissed. Once the patients stopped working because of HIV, returning to work became difficult. In the employed patients, a good workplace environment was strongly related to lower scores on HADS. Higher HADS scores were recorded for employed patients infected with HIV for six years or more. For the unemployed patients, a relationship was observed between strong feelings of stigmatization and HADS scores. Quitting a job because of an experience related to HIV status may be related to feelings of stigmatization. [ABSTRACT FROM AUTHOR]

Background: There is growing recognition that healthcare policy should be guided by the illness experience from a layperson's or insider's perspective. One such area for exploration would include patient-centered research on traumatic Spinal Cord Injury (SCI), a condition associated with permanent physical disability requiring long-term and often complex health care. The chronicity of SCI can, in turn, affect individuals' sense of self. Although previous research in Western countries suggests that people with SCI find a way to cope with their disability through social participation and family bonds, the process of adjustment among people with cervical SCI (CSCI) living in Japan may be different because of the restrained conditions of their social participation and the excessive burden on family caregivers. The purpose of this study was to examine the impact of injury and the process of accommodation in people with CSCI in Japan. Methods: Semi-structured home interviews were conducted with 29 participants who were recruited from a home-visit nursing care provider and three self-help groups. Interviews were recorded, transcribed and analyzed based on the grounded theory approach. Results: Five core categories emerged from the interview data: being at a loss, discrediting self by self and others, taking time in performance, restoring competency, and transcending limitations of disability. Overall, the process by which participants adjusted to and found positive meaning in their lives involved a continuous search for comfortable relationships between self, disability and society. Conclusions: The results of this study suggest that persons with CSCI do not merely have disrupted lives, but find positive meaning through meaningful interactions. Family members added to the discredit of self by making the injured person entirely dependent on them. Gaining independence from family members was the key to restoring competency in people with CSCI. At the same time, social participation was pursued for transcending the limitations of disability. The results also imply that social issues affect how people interpret their disability. These findings suggest that public health policy makers should recognize the need to enhance independence in people with disability as well as change the social assumptions about their care. [ABSTRACT FROM AUTHOR]

This study on individuals with type 2 diabetes living in Japan aimed to examine work-related factors that influence self-care and psychological health among people. A cross-sectional survey was conducted among 121 working adults with type 2 diabetes. A self-report questionnaire assessed demographics, work characteristics, self-disclosure of diabetes, support in the workplace, work-related difficulties due to diabetes, and workplace conformity. Dietary self-care, exercise, depression, and emotional distress were also evaluated. The results indicated statistically significant influence of working night shifts, self-disclosure of diabetes, and workplace conformity on dietary self-care. Work-related difficulties due to diabetes had negative effects on depression and emotional distress, and job control and support in the workplace were found to be correlated with emotional distress. These findings suggest that work-related factors have an impact on some forms of self-care activities and psychological health and that it is important to increase understanding of these issues and provide appropriate support for workers through education and counseling and adjustments in the workplace. [ABSTRACT FROM AUTHOR]

Children in early adolescence and their mothers were studied to clarify the association between a child's sense of coherence (SOC) and its mother's SOC, the quality of family relationships as gauged by the mother, and the child's positive life experiences at home. An anonymous self-administered group questionnaire was given to all 1540 students of a high school in Tokyo, and a similar questionnaire was sent by mail to their legal guardians. Responses were received from 1505 students (response rate: 97.7%) and 989 legal guardians (response rate: 64.2%); questionnaires completed by legal guardians who were the mothers of the students were paired with the corresponding child's questionnaire. The SOC scores of mothers and students were calculated, and hierarchical multiple regression analysis was performed with the student's SOC as a dependent variable. Results for boys revealed that a mother's SOC was directly related to the child's SOC, regardless of family relationships and participation in decision-making at home. For girls, a mother's SOC was related to family relationships and was indirectly related to the child's SOC through the child's participation in decision-making at home. Results revealed that for both boys and girls, a mother's SOC had an effect on the child's SOC, and this corroborates the hypothesis of Antonovsky. [ABSTRACT FROM AUTHOR]

This is the preliminary report of a study to evaluate the effectiveness of the Chronic Disease Self-management Program in Japan by comparing changes in health outcomes at the baseline and 3-month and 6-month follow-ups. The program is a patient-centered educational program for the self-management of chronic conditions. The study's participants were recruited from among the attendees of the program workshops. During the study period (August 2006 to May 2007), 18 workshops were held and 128 attendees agreed to participate in the study. The health outcomes that were measured included health status, self-management behaviors, utilization of health services, self-efficacy, satisfaction with daily living, and clinical indicators. These indicators were further analyzed by disease type: diabetes, rheumatic disease, and cardiovascular disease/dyslipidemia. The findings indicated statistically significant positive changes in health distress, coping with symptoms, stretching exercises, communication with the physician, and satisfaction with daily living. The positive changes were especially remarkable among the groups with diabetes and rheumatic disease. These findings suggest that the Chronic Disease Self-management Program can be effective for Japanese people with chronic conditions. [ABSTRACT FROM AUTHOR]

The article focuses on a study undertaken to study the evaluation of a web-based stress management program aimed at improving the positive psychological function and psychological well-being of a person. The cohort study conducted among white-collar workers in Japan was carried out by asking four questions related to enjoyment, self-efficacy and enjoyment. The study highlights that the program can be effective when the participants feel enjoyment and improve their ability to cope with stress.

Background: Pervasive developmental disorder (PDD) has an uncertain etiology, no method of treatment, and results in communication deficiencies and other behavioral problems. As the reported recurrence risk is 5%-10% and there are no methods of either prevention or prenatal testing, mothers of PDD children may face unique challenges when contemplating second pregnancies. The purpose of this study was to explore the mothers' lived experiences of second child-related decision-making after the birth of a child with PDD. Methods: The participants for this study were restricted to mothers living within the greater Tokyo metropolitan area who had given birth to a first child with PDD within the past 18 years. The ten participants were encouraged to describe their experiences of second-child related decision-making after the birth of a child with PDD on the basis of semi-structured interviews. Data analysis was performed by using Interpretive Phenomenological Analysis (IPA), which is concerned with understanding what the participant thinks or believes about the topic under discussion. Results: We identified two superordinate themes. The first was balancing hopes and fears, in which hope was the potential joy to be gained by the birth of a new child without PDD and fears were characterized as uncertainty of PDD and perception of recurrence risk, burden on later-born children, and negative effects on a child with PDD. The second superordinate theme was assessing the manageability of the situation, which was affected by factors as diverse as severity of PDD, relationship between mother and father, and social support and acceptance for PDD. Our 10 participants suffered from extreme psychological conflict, and lack of social support and acceptance for PDD created numerous practical difficulties in having second children. Conclusions: Our participants faced various difficulties when considering second pregnancies after the birth of children with PDD in the Japanese society. As lack of social support and acceptance for PDD also played a large role in second child-related decision-making, creating a social environment that more fully accepts those disabled and providing flexible support systems for families of children with PDD are crucial. [ABSTRACT FROM AUTHOR]

Japanese families traditionally avoid disclosing diagnoses of terminal illnesses to patients, seeking to protect the patient from emotional pain and shock. Using awareness theory, in this study we aimed to investigate the attitudes toward disclosure among bereaved families of Japanese hemophiliacs with iatrogenic HIV/AIDS. Semistructured interviews were conducted with 34 bereaved family members. Qualitative content analysis centered around three main issues: (a) family attitudes toward physician nondisclosure of HIV diagnosis; (b) family attitudes regarding the consequences of nondisclosure; and (c) family attitudes regarding the impact of nondisclosure on patient-family relationships. Our findings suggest that families favored disclosure because they felt that knowledge of the iatrogenic HIV infection would benefit the patient. [ABSTRACT FROM AUTHOR]

Physicians in Japan typically do not disclose diagnoses of terminal illnesses to patients, in deference to the wishes of family members. Nonetheless, some evidence indicates that relatives of patients with iatrogenic HIV infection would prefer patient disclosure. We collected survey data from 314 family members in 225 households of hemophiliac patients who died from illnesses related to iatrogenic HIV infection in order to examine current attitudes toward patient disclosure in Japan. Family members reported that the diagnosis of iatrogenic HIV infection was disclosed to the patient by the primary physician in 32.8% of cases, by the family in 8.3% of cases, and not disclosed in 26.4% of cases. The majority of families indicated that the timing of the physician's disclosure occurred too late. Multivariate analysis indicated that families wished that patients had been informed of the diagnosis, despite the stigma associated with HIV in Japan. Furthermore, many families blamed the physician for the infection and fatality in those cases in which the physician did not convey feelings of regret. These results have important clinical ramifications to the practice of disclosing terminal diagnoses in Japan. [ABSTRACT FROM AUTHOR]

Abstract: “Sense of Coherence” (SOC) is a core concept of salutogenic theory. This concept can be usefully applied to analyses of stress prevention and health maintenance. Little is known about how factors that correlate with individuals’ SOC vary according to regional socio-cultural conditions. The objective was to examine if living environment influenced the pattern of correlations of SOC with generalized resistance resources (GRRs) and to assess if between area SOC differences relate to GRRs. We sought to examine the relationship between SOC and psychosocial GRRs, including sociodemographic characteristics based on Antonovsky’s theories. Social support and self-efficacy were found to correlate with SOC among both urban and rural residents. SOC was correlated with economic status among urban residents, but not among rural residents; further, in rural areas alone, SOC was found to correlate with residential intention, ties with relatives, and humor. Urban residents in general showed significantly higher SOC scores than rural residents. This may be due to the higher levels of social support, self-efficacy, and higher economic status found among urban residents. We suggest that the practical application of theories of SOC to health policy development in urban and rural areas may benefit from taking into account SOC related characteristics. [Copyright &y& Elsevier]

To evaluate the intent and practice of condom use among Japanese HIV-positive men who have sex with men (MSM), a survey using anonymous questionnaires was carried out and 117 respondents were investigated. For anal sex and oral sex, respectively, 58.1% and 15.2% intended to use condoms and 47.2% and 12.4% used condoms all of the time. The intent of condom use decisively affected the practice of condom use and was closely related to the perceived risk level of HIV/sexually transmitted (STI) transmission. In anal sex, willingness to protect sexual partners from HIV infection was strongly related not only to the intent but also to the practice. Enhancement of willingness to protect oneself from STI was suggested to enhance willingness to protect his/her sexual partners from HIV infection with secondary enhancement of the intent or the practice of condom use. Specific support of MSM with HIV for improving the intent and practice of condom use is urgently needed. [ABSTRACT FROM AUTHOR]

Abstract: This research examined the experience of Amyotrophic Lateral Sclerosis (ALS) patients who depend on an invasive mechanical ventilator in Japan. We investigated their difficulties in expressing their needs, their desires and wishes, and their sources of support and happiness. We examined the relationship between these factors and patient demographics, and hope as an indicator of successful adaptation to the illness experience (assessed by the Herth Hope Index). Interview results guided the formation of an anonymous questionnaire distributed to patients by mail. We interviewed 27 patients and their families and surveyed 157 respondents with a questionnaire. Most patients experienced multiple categories of difficulties, which correlated with reduced hope. More severe physical symptoms correlated with more emotional and social difficulties. Notable findings included a high prevalence of unalleviated pain, fear or experience of ventilator difficulties, and fear of burdening others. Having more sources of psychosocial support and happiness was associated with greater hope. Living at home was associated with fewer social difficulties. No patients claimed additional sources of support without claiming family or professional caregiver support, suggesting their mediation may be crucial in maintaining other social connections. Users of computer communication reported more sources of support and happiness and less frustration from difficulty expressing themselves. The most common reported desires, following a cure for ALS, related to the happiness of the patients’ families, and a desire not to burden them. We also found that invasive mechanical ventilation (IMV) had been initiated emergently in 30.1% of patients without patient or family consent. Our results provide an insight into the world of this challenged population, elucidating the difficulties they face, and clarifying the role of support and other factors in maintaining hope. We identify concrete areas to which increased attention should be directed in patient care. [Copyright &y& Elsevier]

The social and political environments surrounding patient-physician relationship have been changing in Japan for the last few decades. This paper aims to illustrate social and cultural factors that underlie current situations and problems of patient-physician relationship in Japan through a comparison with those in western countries, and to consider how mutual participation model of patient-physician relationship could be applied and fostered in Japan as well as other Asian cultures. Four major sociocultural factors are discussed in relation to the patient-physician relationship in Japan: (1) individualism versus collectivism; (2) low context versus high context; (3) femininity versus masculinity; and (4) Christianity versus Confucianism. Two key issues in discussing the mutual participation model of patient-physician relationship in Japan have emerged; the family and the communication style. The patient autonomy in Japan should be considered within the context of the triadic relationship of patient, family, and physician. Also, since the communication style might differ between Japan and western countries, communication training programs and interventions for medical professionals as well as for patients should be tailored in a culturally appropriate way in order to improve the communication in medical encounters and to achieve the mutual participation. Beyond mere advocacy of the patient autonomy, the mutual participation model of patient-physician relationship should be pursued within our social and cultural context to be truly fruitful for patients and physicians in Japan. [ABSTRACT FROM AUTHOR]

In Japan, as in other advanced industrial societies, user-helper relationships shaped by the Independent Living Movement have gradually been taking root. In this study, we interviewed 31 Center for Independent Living (CIL) consumers in Japan in order to explore the nature of the relationship between persons with disabilities influenced by IL ideals and their assistants. Interviews revealed three significant dimensions to the relationship—one functional, one interpersonal and one collective. The functional dimension of the relationship was expressed in a characterization of assistants as 'instruments', the interpersonal dimension in their characterization as 'employees' (a task-orientated aspect) and 'companions' (a socio-emotional aspect), and the collective dimension in the characterization of assistants as 'social assets'—individuals without disabilities who understand the ideals and demands of independent living. Participant responses also form the basis of our discussion of theoretical and practical implications for the building of user-helper relationships based within a user-centred agency in the context of Japanese medical and social services. [ABSTRACT FROM AUTHOR]

Examines the relationship between the outpatients' perception of physicians' communication styles and anxiety levels of patients in Japan. Measurement of anxiety level of patients; Development of the Perceived Physician's Communication Style Scale; Effects of the communication style of physicians on post-consultation anxiety levels of patients.

Benefit finding has been defined as positive life changes that result from a stressful event, such as the diagnosis of chronic illness. The present study aimed to develop a benefit finding questionnaire (BFQ) and examine its psychometric property among people with chronic mental illness in Japan. This study adopted a mixed method composed of three phases, including Phase 1: To draft the item pool and design the BFQ based on literature review and discussion among the authors, Phase 2: To revise and refine the drafted items through feedback from focus group interviews and further consideration, and Phase 3: To examine the psychometric properties of the BFQ following the questionnaire survey for people with chronic mental illness and validation of the questionnaire. In Phase 3, a cross-sectional, self-administered questionnaire survey was conducted for mental health service users. Among the 373 eligible participants, we used data from 265 respondents for the analyses (valid response rate = 71.0%). About 65% were male, and the average age was 45.3 years (SD = 12.9). Around 70% were diagnosed with schizophrenia. Factorial, concurrent, and divergent validities, as well as reliability were explored. The 21-item BFQ demonstrated good factorial validity, concurrent and divergent validities, and sufficient internal consistency reliability among people with chronic mental illness. It appears to be a useful scale to assess experience of benefit finding among people with chronic mental illness. Further large-scale research will ensure verification of the scale among people with other illnesses or difficulties. [ABSTRACT FROM AUTHOR]

Background: To improve and support medication adherence among patients with chronic diseases, especially for long-term medication, it is important to consider both their relationship with healthcare providers and their lifestyle. We tested the reliability and validity of a modified 12-item Medication Adherence Scale.Methods: We revised a 14-item measure of medication adherence, created in 2009, to a more concise and clear 12-item version, and we verified the reliability and validity of the 12-item scale. We included 328 patients with chronic diseases participating in the Chronic Disease Self-Management Program in Japan from 2011 to 2014. Confirmatory factor analysis was used to assess whether the four factors assessed were the same as the previous 14-item Medication Adherence Scale. Cronbach's coefficient alpha was used to assess internal consistency reliability, and the relationships between patient demographic characteristics and medication adherence were compared with previous studies.Results: The 12 items were categorized into the four factors "medication compliance", "collaboration with healthcare providers", "willingness to access and use information about medication", and "acceptance to take medication and how taking medication fits patient's lifestyle". Confirmatory factor analysis showed χ2/df = 2.6, CFI = 0.94, and RMSEA = 0.069. Cronbach's alpha for the 12-item scale was 0.78. Cronbach's alpha for the four subscales was 0.74, 0.81, 0.67, and 0.45. Higher medication adherence was significantly associated with being a female patient, living with someone else, and age 40-49 years versus age 20-29 years. These relationships were the same as in previous studies.Conclusions: We modified our original 14-item scale to a 12-item Medication Adherence Scale for patients with chronic diseases, which considers their relationship with healthcare providers and lifestyle. Refinement might be needed because of the relatively low reliability of subscales. However, the modified scale is expected to contribute to more effective self-management of medication and to improving medication adherence, particularly among patients with chronic diseases who require long-term medication not only in Japan but also in other countries. [ABSTRACT FROM AUTHOR]

Objective: To compare support for three groups by considering usage patterns with regard to two peer support resources, online communities, and face-to-face support groups, among patients with breast cancer in Japan. Methods: We conducted a cross-sectional survey of 1039 breast cancer patients. Results: Factor analysis indicated that all groups show the five aspects of support: “Emotional support/Helper therapy,” “Emotional expression,” “Conflict,” “Advice,” and “Insight/Universality.” Within the group using two support resources, the support scores of “Emotional expression” and “Advice” were higher for the online community, and those of “Emotional support/Helper therapy,” and “Insight/Universality” were higher for the face-to-face support group. Among the three groups, the members who received the most peer support were those who used both an online community and a face-to-face support group. Conclusion: Patients who received the most social support from peers were in the group using both online communities and face-to-face support groups. Practice implications: Healthcare providers should provide information about peer support through not only traditional face-to-face support groups but also online communities. [Copyright &y& Elsevier]

Abstract: This study sought to investigate the psychosocial difficulties faced by bereaved families of HIV-infected hemophiliacs in Japan, with the goal of clarifying appropriate ways to offer them support. Interviews were conducted with 46 family members from 36 families, and a written survey was mailed to 392 families. Valid responses from 225 families (307 family members) were analyzed (response rate 57.4%). We found that even at a mean 7–9 years after their family member''s death, the bereaved continued to express deep feelings of sorrow and grief, and further, expressed strong feelings of resentment, anger, guilt and regret, anxiety over discrimination, and loneliness. Notably, 95% of the mothers endorsed feeling “sorry for giving birth to a hemophiliac child”. Additionally, even after their family member''s death, approximately 70% of the respondents continued to restrict their daily activities due to stigmatization or anxiety over discrimination. Finally, 59% of the respondents were found to have posttraumatic stress disorder-like symptoms according to the Impact of Event Scale-Revised, and 46% were found, according to General Health Questionnaire-12 (a measure of mental disorder) criteria, to suffer mental health problems. These results indicate that bereaved families of HIV-infected hemophiliacs in Japan have special characteristics and psychosocial needs, and still suffer significant psychosocial difficulties years after the bereavement. [Copyright &y& Elsevier]

Over the past few decades, physician-patient communication has been intensively studied in western countries, because of its importance for the physician-patient relationship and patient health outcomes. Although various concepts and models of this relationship have recently been introduced in Japan, there are few studies on Japanese physician-patient interaction. The purpose of this study is to describe characteristics of physician patient communication in a Japanese cancer consultation, and to examine the relation of this interaction with patient satisfaction. One hundred and forty cancer outpatients and twelve physicians were included. The Roter Interaction Analysis System (RIAS), one of the most frequently used systems for analyzing physician patient interaction, was applied, physicians made more utterances directing the interaction than patients did, and their discussion was largely focused on biomedical topics. It can be concluded that the structure of the physician-patient interaction in our study was basically similar to those in previous western studies, although some differences were also found. The relation between physician-patient communication and patient satisfaction was generally consistent with previous studies. Patients were more satisfied with consultations in which the physician used more open-ended questions. On the other hand, physician direction and encouragement was negatively associated with patient satisfaction. Also, patients who asked more questions were less satisfied with the consultation. [ABSTRACT FROM AUTHOR]

Objectives: The amount of research relating to evaluation of intervention programs with regard to sense of coherence, a concept of salutogenic stressor coping capacity, is increasing in Japan. However, a nationally representative score of the Japanese version of the sense of coherence scale has not yet been reported. The aim of this study was to describe the 13-item, 7-point Japanese sense of coherence scale (SOC-13), with scoring by sex and age group, and to examine the relationships between the score and locality and city size., Methods: Four thousand Japanese men and women were selected by stratified random sampling, and a cross-sectional, self-administered questionnaire survey was conducted using the placement method. Responses were obtained from 2,067 individuals (response rate: 51.7%). This study analyzed 956 men and 1,107 women (mean age [standard deviation]: 50.0 [14.3])., Results: The mean score on the SOC-13 was 59.0 (12.2) in all participants, 59.1 (11.8) in men, and 58.9 (12.5) in women. No significant difference was found between men and women (P=0.784). ANOVA and multiple comparison for age difference showed a clear relationship (P<0.05) between higher age and a higher SOC-13 score. Moreover, the results of main and interaction effects in ANCOVA, with independent variables for locality (11 segments) and city size (four segments), were not significant when controlled for age., Conclusion: A nationally representative score for the Japanese SOC-13 was acquired. In future research, application of the SOC-13 in Japan for clinical studies is anticipated based on the nationally representative score.

Background: The salutogenic model states that coping resources are defined within sociocultural and historical contexts and that various social and historical factors influence the availability of such resources. Though previous studies have suggested the need for an interregional comparison of psychological and social resources, few studies have undertaken such an investigation. The aim of this study is to investigate the associations among coping resources, sense of coherence (SOC), and health status in a comparison of urban and rural residents., Methods: General residents (aged 30-69 years) in two areas were targeted for the current study. Through a random sampling selection, 1,000 residents from each area were picked, and an anonymous questionnaire was mailed to each resident. Ultimately, 269 and 363 valid responses from the urban and rural areas, respectively, were analyzed. SOC, both social and psychological resources, and mental health were assessed. To examine relationships between SOC and resources associated with mental health, mental health was defined as a dependent variable. Hierarchical multiple regression was conducted with variables entered from sociodemographic characteristics, social and psychological resources, and SOC., Results: Regarding regional characteristics, social capital and participation in community activities were significantly greater in the rural area than in the urban area. Urban residents reported significantly higher self-esteem and optimism than rural residents. SOC showed the most significant association with mental health in both areas. Mental health was significantly associated with physical activity limitations and life stressors in both areas. However, the associations were weakened when social and psychological resources and SOC were added, which demonstrated their buffering effect on the negative influence of life stressors on health. When SOC was added, the association of self-esteem with mental health disappeared in both areas, but optimism in the urban area and humor in the rural area were directly and independently associated with mental health., Conclusions: Our findings indicate that resources available to urban and rural residents are characteristic of the area where they live, and that social and psychological resources as well as SOC are associated with better mental health. Possible directions for health support strategies, reflecting regional characteristics, are suggested.

The aim of this study was to use longitudinal data and investigate by sex the following four hypotheses on the relationship between sense of coherence (SOC) and work environment (WE): (i) a bidirectional cause-effect relationship exists; (ii) WE is the cause and SOC is the effect; (iii) SOC is the cause and WE is the effect; and (iv) no cause-effect relationship exists. Male and female subjects between the ages of 20 and 40 living in Japan were selected as subjects by two-stage stratified random sampling, and self-administered questionnaires were sent by mail between January and March 2007 (Time 1). A follow-up was conducted in the same way from January to March of 2008 (Time 2). Responses were obtained from 3,965 individuals (follow-up ratio: 82.6%). This study analyzed 1,291 males and 933 females who were at least 25 years old at Time 1 and who worked the same job in both time periods. The analysis was performed using a cross-lagged model under structural equation modeling. The second hypothesis was selected for both males and females based on the outcome of nested model comparisons. That is, a temporal cause-effect relationship was observed between SOC and WE for both males and females, with WE as the cause and SOC as the effect.

Background: Web 2.0 has improved interactions among peers on the Internet, especially for the many online patient communities that have emerged over the past decades. Online communities are said to be particularly beneficial peer support resources for patients with breast cancer. However, most studies of online patient communities have focused on those members who post actively (posters), even though there are many members who participate without posting (lurkers). In addition, little attention has been paid to the usage of online communities among non-English-speaking patients., Objective: The present study explored the differences in peer support received by lurkers and posters in online breast cancer communities. It also examined the effects of such support on both groups' mental health., Methods: We conducted an exploratory, descriptive, cross-sectional, Web-based survey among members of four Japanese online breast cancer communities. In an online questionnaire, we asked questions regarding sociodemographics, disease-related characteristics, mental health, participation in online communities, and peer support received from those communities., Results: Of the 465 people who accessed the questionnaire, 253 completed it. Of the respondents, 113/220 (51.4%) were lurkers. There was no significant difference between lurkers and posters with regard to sociodemographic variables. About half of the posters had been given a diagnosis of breast cancer less than a year previously, which was a significantly shorter period than that of the lurkers (P = .02). The 5 support functions extracted by factor analysis were the same for both posters and lurkers. These were emotional support/helper therapy, emotional expression, conflict, advice, and insight/universality. When the support scores were calculated, insight/universality scored highest for both posters and lurkers, with scores that were not significantly different between the two groups. Among the 5 support scores, emotional support/helper therapy and emotional expression were significantly higher among posters. For posters, emotional support/helper therapy and advice were negatively correlated with the anxiety subscale of the Hospital Anxiety and Depression Scale. Emotional expression, advice, and insight/universality were negatively correlated with the anxiety subscale for lurkers., Conclusion: We found that posters felt they received more benefits from online communities than lurkers did, including emotional support, helping other patients, and expressing their emotions. Yet even lurkers were found to gain a certain amount of peer support through online communities, especially with regard to advice and insight/universality. The results demonstrate that participation in online communities--even as a lurker--may be beneficial to breast cancer patients' mental health.

Background: Research on health-education programs requires longitudinal data. Loss to follow-up can lead to imprecision and bias, and complete loss to follow-up is particularly damaging. If that loss is predictable, then efforts to prevent it can be focused on those program participants who are at the highest risk. We identified predictors of complete loss to follow-up in a longitudinal cohort study., Methods: Data were collected over 1 year in a study of adults with chronic illnesses who were in a program to learn self-management skills. Following baseline measurements, the program had one group-discussion session each week for six weeks. Follow-up questionnaires were sent 3, 6, and 12 months after the baseline measurement. A person was classified as completely lost to follow-up if none of those three follow-up questionnaires had been returned by two months after the last one was sent.We tested two hypotheses: that complete loss to follow-up was directly associated with the number of absences from the program sessions, and that it was less common among people who had had face-to-face contact with one of the researchers. We also tested predictors of data loss identified previously and examined associations with specific diagnoses.Using the unpaired t-test, the U test, Fisher's exact test, and logistic regression, we identified good predictors of complete loss to follow-up., Results: The prevalence of complete loss to follow-up was 12.2% (50/409). Complete loss to follow-up was directly related to the number of absences (odds ratio; 95% confidence interval: 1.78; 1.49-2.12), and it was inversely related to age (0.97; 0.95-0.99). Complete loss to follow-up was less common among people who had met one of the researchers (0.51; 0.28-0.95) and among those with connective tissue disease (0.29; 0.09-0.98). For the multivariate logistic model the area under the ROC curve was 0.77., Conclusions: Complete loss to follow-up after this health-education program can be predicted to some extent from data that are easy to collect (age, number of absences, and diagnosis). Also, face-to-face contact with a researcher deserves further study as a way of increasing participation in follow-up, and health-education programs should include it.

Aim: Work-family conflict (WFC) refers to the conflict that arises between a person's work and family life. Previous studies have reported workload, job demands, and irregular working shifts as related to the WFC among nurses and have clarified that WFC is a predictor of job satisfaction, morale, and turnover intention. Very few studies have investigated WFC among Japanese nurses and no study has taken into consideration the sense of coherence (SOC) that helps nurses to cope with stress. The present study aimed to determine the relationship between WFC and SOC and to clarify how WFC and a SOC influence the mental and physical health of nurses in order to suggest ways of establishing work environments that enable nurses to achieve a balance between their work and family life., Methods: A self-report questionnaire survey of 388 Japanese female nurses was conducted. The data from 138 nurses who were a mother and/or wife were analyzed., Results: Work-family conflict was significantly related to the SOC. It had a larger impact on the physical and mental health of nurses than their work and family characteristics. The SOC also had a major influence on the physical and mental health of nurses, while having a buffering effect on WFC with respect to depression., Conclusions: Our findings underscore the importance of taking organizational steps to create work environments that contribute to an enhanced SOC in order to reduce the WFC among nurses., (© 2010 The Authors. Japan Journal of Nursing Science © 2010 Japan Academy of Nursing Science.)

Japan's 2008 health policy focuses more than ever on health education for behaviour change and outcome measures for physical health status. This is at odds with contemporary health promotion and health education, which frame health as a resource for everyday life and indicate that the evaluation of interventions should measure broader aspects of health rather than just physical aspects. The application of a combination of different health communication models and theories allows for a customized approach, depending on the types of change that are being sought, and can lead to increased relevance as well as a better fit when it comes to evaluating the achievement of broad health promotion goals. This article explores the application of the Outcome Model for Health Promotion to a two-year health education intervention in Kushima, Japan. This model measures program effectiveness from four aspects: physical health outcomes; intermediate health outcomes; health promotion outcomes; and health promotion actions. A quantitative and qualitative longitudinal, mixed model study design and methods were used for the analysis. Data was taken from health exams, structured interviews, and participant observations collected from 67 participants at four times over two years. This intervention relied primarily on health education and communication to achieve mental and social health outcomes more significantly and faster than physical health outcomes. The importance of moving outcome measurement beyond direct health achievements is discussed in light of the relationships between physical, mental, and social health and its determinants, and our results.

Objective: The consultation rate in Japan for mammography screening for breast cancer continues to drop. In order to examine this issue based on demand for mammography, the present study was conducted using Discrete Choice Experiments (DCEs), a type of Stated Preference (SP) method. The objectives of this study were as follows: (1) To consider what attributes of mammography screening are being potentially evaluated by general recipients in the target age group; (2) To verify the validity of the SP method by separating the sample group into sub-groups of previous mammography recipients and non-recipients, and to compare their findings; (3) To predict selection behavior by setting scenarios for screening options possibly in demand in the future., Methods: 800 subjects aged between 40 to 59 years and with no history of breast cancer were randomly selected from the general population of Tokyo. A DCE was conducted using postal self-administered survey forms. A total of 301 survey responses were obtained. Subjects were presented with a pair of hypothetical screenings, including 5 attributes regarding mammography screening, and asked which screening they would prefer to receive. For the entire sample and sub-groups, estimations for parameters were made using the conditional logit model setting the screening attributes as independent variables and the selection of whether or not to receive each screening as a dependent variable. Based on these results, short-time/high-cost and long-time/low-cost screening options were set and selection behavior was predicted., Results: The five attributes regarding mammography screening for all samples--total amount of time taken for the screening; degree of breast pain; possibility of breast cancer being missed during the screening; the effectiveness of reducing deaths caused by breast cancer; and the total cost required for the screening--were each estimated to be significant at the 5% level with coefficient signs consistent with expectations for the entire sample group. Next, comparing the estimated results of the sub-groups, a positive correlation was confirmed between behavior and preference. As for forecast of selection behavior, the percentage of respondents choosing the short-time option was predicted to be the same or higher than for those choosing long-time/low-cost option when the short-time option was offered for Yen 7500 or less., Conclusion: This study shows that subjects place significant value on attributes regarding the screening process as well as actual health outcomes. It also suggests the validity of using the SP methods in examining screening preferences. We found that short-time screening was able to compete against long-time/low-cost screening when it was offered for Yen 7500 or less. These results suggest that offering mammography screening with favorable settings could increase the demand.

Currently in Japan, discontinuing an invasive mechanical ventilator (IMV) is illegal; therefore IMV-related decision making is a crucial issue. This study examined IMV decision-making factors and psychological conflict in 50 patients with amyotrophic lateral sclerosis. The Herth Hope Index was used for the assessment of pre- and post-IMV conflict. Interviews identified some decision-making factors: patient's decision, patient's and family's mutual decision, family's decision, and emergency-induced without patient's or family's consent. Participants who experienced no IMV-related regret received sufficient prior IMV education from physicians and nurses, and time for reflection and family consultation. Their hope was similar to their pre-onset levels. Patients who received no prior IMV education accepted treatment as a natural progression. Their hope levels were lower than pre-onset. Those who received only a brief prior IMV explanation rejected the ventilator, experiencing regret if they were given an emergency IMV. Their hope levels were among the lowest. However, some of these patients managed to overcome their regret through being helped by nurses. Sufficient physician explanation and nursing advocacy for autonomous patient decision making are critical for improving hope in this patient group.

Background: Health literacy (HL), the capacity of individuals to access, understand and use health information to make informed and appropriate health-related decisions, is recognized as an important concept in patient education and disease management., Objective: To examine the relation of three levels of HL (i.e. functional, communicative and critical HL) to patient-physician information exchange during a visit., Methods: Participants were 134 outpatients with type 2 diabetes who were under continuous care by four attending physicians at a university-affiliated hospital. The visit communication was recorded and analysed using the Roter Interaction Analysis System. Patient HL was measured through a self-reported questionnaire using newly developed self-rated scales of functional, communicative and critical HL. Sociodemographic and clinical characteristics and patient's perception of the information exchange were assessed for each patient through self-reported questionnaires and review of electronic medical records., Results: Patient HL levels were related to the information exchange process during the visit. Among the three HL scales, communicative HL (the capacity to extract information, derive meaning from different forms of communication and apply new information to changing circumstances) was related to patient's perceptions of the information exchange. Further, patient communicative HL had a modifying effect on the relationship between physician's information giving and patient's perception of it, suggesting that physician's communication may be perceived differently depending on the patient's HL., Conclusion: The exploration of patient HL may provide a better understanding of potential barriers to patient-physician communication and patient's self-management of disease.

Objectives: The aims of this study of Japanese married employees were: 1) to examine the relationship between work-related factors and work-to-family conflict (WFC); 2) to examine the relationship between WFC and fatigue and depression; and 3) to explore the role of family togetherness in a path between WFC and health., Methods: A cross-sectional survey was conducted among employees belonging to a labor union federation of the chemical industry. All analyses were conducted by subgroup according to gender and parental status., Results: Data was collected from 12 companies located in the Tokyo metropolitan area from September to October 2005. The data of 961 married employees were analyzed. The main findings by regression analyses were: 1) high job demands, low job control, and unsupportive work-family culture were associated with high level of WFC; 2) WFC was positively associated with fatigue and depression regardless of gender and parental status; and 3) maintaining family togetherness was slightly, yet significantly associated with fatigue in the father group., Conclusions: WFC was unfavorably related to fatigue and depression in both genders regardless of parental status, and plays a role linking unfavorable work situations and health. As possible work-related factors of WFC, the data indicate not only individual workplace variables but also an organizational support. Additionally, maintaining family togetherness appears to benefit fathers by preventing fatigue. Strategies for reduction of WFC are therefore necessary to promote health among married workers of both genders.

Purpose: The purpose of this paper is to describe the relationship between job stress, stress coping ability and performance among Japanese nurses., Design/methodology/approach: Health risk and organization environment as job stress factors, sense of coherence (SOC) as stress coping ability and medical risk indicator and sickness-absence days as a performance proxy were used to investigate the relationship between stress and performance. Length of professional experience also was included in the investigation., Findings: The findings suggest a possibility that enriching nurses' professional experiences reduces medical risk. There is also a possibility that raising the SOC, while improving organization environment, contributes to reducing sickness-absence., Research Limitations/implications: A cross-sectional study of nurses in a single institution was used. In order to generalize the study's results, it will be necessary to conduct multi-institutional longitudinal studies., Originality/value: The present study shows key factors affecting medical risk and sickness-absence leading to a reduced nursing performance.

This study describes the current status of peer support through an online community among patients with breast cancer, and examines how the support differs through the patients' usage of the community. Self-reported questionnaires distributed to 465 patients through Internet were analyzed. Analysis indicated the peer support among patients was categorized according to the following 5 factors: "emotional support, helper-therapy," "emotional expression," "conflict," "advice," and "insight, universality." Even the patients who only read the postings of other patients received benefits from the community.

The realization of positive life influences resulting from the experience of chronic illness has been conceptualized as "benefit-finding". This study of individuals with rheumatoid arthritis in Japan aimed to describe the nature of benefit finding; examine its predictive social factors and evaluate its impact on mental health. A web-based questionnaire was conducted, with valid responses obtained from 364 persons aged 20-59 years. The results indicated that a majority of the participants reported engaging in some type of benefit-finding. "Developing compassion towards others" and "an appreciation of things not previously important" were the most commonly reported. The patients reporting larger emotional support networks and those performing more self-care activities reported achieving higher levels of benefit-finding. Of all the factors examined, benefit-finding was the most significant predictor of mental health. These results expand the base of knowledge regarding living with rheumatoid arthritis and offer practical suggestions for the promotion of well-being.

Purpose: Keratoconus is a chronic, noninflammatory, degenerative disease of the cornea that has an onset in young adulthood. The objective of this study was to evaluate vision-related quality of life (VR-QOL) in patients with keratoconus by using the Japanese version of the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25)., Methods: Forty-five patients diagnosed with keratoconus at the Keio University School of Medicine were enrolled. Patients were divided into three subgroups according to corrected visual acuity. Group A included patients whose best-corrected visual acuity was at least 20/20 in both eyes. Group B included patients with a best-corrected visual acuity of at least 20/20 in only one eye. Group C included patients whose best-corrected visual acuity was worse than 20/20 in both eyes. Thirty-six age-matched subjects were recruited as control subjects. The Japanese version of the NEI-VFQ-25 was administered to each subject., Results: All NEI-VFQ-25 subscale scores were significantly lower (P<0.05) in patients with keratoconus than in the control subjects. Subscales evaluating general health, ocular pain, and vision-specific mental health showed particularly low values. Among patients with keratoconus, every subscale score other than color vision correlated with corrected visual acuity., Conclusions: The results support that and describe how multidimensional visual function and VR-QOL are impaired in patients with keratoconus, including those with normal visual acuity. Ophthalmologists and other clinicians should carefully evaluate and address the full range of quality of life issues that may affect patients with keratoconus.

Objective: Elderly patients are often accompanied during medical visits by a companion, usually a family member. This study explores the association between patients' expectations regarding the communication role of their companions, and the role intended and taken by companions during the medical visits, on patient perceptions of companion helpfulness., Methods: Participants included 63 patients aged 65 or over who were under continuous care of nine attending physicians at a university-affiliated geriatric clinic in Tokyo, and their companions during the medical visit. These medical visits were audiotape recorded and coded using a Japanese translation of the Roter Interaction Analysis System (RIAS)., Results: The discrepancy between what patients expected of their companions, and what companions intended and actually did during the visit, predicted patient ratings of companion helpfulness. It was especially noteworthy that the highest ratings of companion helpfulness occurred when patients expected their companion to be actively involved in communication and they were. However, if the patient anticipated only a limited companion role, the companion was not viewed as very helpful regardless of the role they played., Discussion: There would be a largely unexploited potential for improving communication effectiveness through the optimal engagement of companions in visit communication.

Aim: The aim of this study was to explore quantitatively which working conditions influence the occurrence of medical near-miss errors related to intravenous medication at a hospital in Japan., Background: Although working conditions such as stress, fatigue and inexperience have been reported to contribute to medical errors, countermeasures to these conditions have been delayed, and working conditions have deteriorated in many Japanese medical sites., Methods: A self-reporting questionnaire analysing working conditions that can lead to near-miss errors relating to intravenous medication was sent to 90 nurses working in four wards of one Japanese hospital in 2001. Eighty-eight subjects responded (response rate: 97.8%). Among 534 person-days in which 88 nurses attended works, 525 person-days of data were used for the analyses., Results: Among 525 person-days, the number of near-miss errors was 94 (17.9%). There was no significant difference in the occurrence of near-miss errors among the three shifts (day shift, 19.2%; evening shift, 19.2%; night shift, 12.5%). During the day shift, errors were reported at a significantly higher frequency when the nursing services were delayed longer due to workload. During the evening shift, errors were reported when the nursing services were delayed longer due to workload and when years of experience at the current ward were shorter. In addition, nurses whose perceived level of fatigue before work was lower during the day shift, and nurses whose years of experience as a nurse were longer and who had longer sleep duration during the evening shift experienced near-miss errors with a significantly higher frequency than other nurses. These latter factors could be important conditions that encourage the detection of errors before they occur., Conclusions: Workload and lack of experience at the current ward are two conditions that can lead to errors. Furthermore, lack of fatigue and long experience as a nurse may help encourage the detection of errors before they occur. It is important to improve working conditions so that health care workers can detect errors before patients are harmed and decrease the number of errors that occur.

Purpose: In community and workplace health plans, the Perceived Health Competence Scale (PHCS) is employed as an index of health competency. The purpose of this research was to examine the reliability and validity of a modified Japanese PHCS., Methods: Interviews were sought with 3,000 randomly selected Japanese individuals using a two-step stratified method. Valid PHCS responses were obtained from 1,910 individuals, yielding a 63.7% response rate. Reliability was assessed using Cronbach's alpha coefficient (henceforth, alpha) to evaluate internal consistency, and by employing item-total correlation and alpha coefficient analyses to assess the effect of removal of variables from the model. To examine content validity, we assessed the correlation between the PHCS score and four respondent attribute characteristics, that is, sex, age, the presence of chronic disease, and the existence of chronic disease at age 18. The correlation between PHCS score and commonly employed healthy lifestyle indices was examined to assess construct validity. General linear model statistical analysis was employed., Results: The modified Japanese PHCS demonstrated a satisfactory alpha coefficient of 0.869. Moreover, reliability was confirmed by item-total correlation and alpha coefficient analyses after removal of variables from the model. Differences in PHCS scores were seen between individuals 60 years and older, and younger individuals. These with current chronic disease, or who had had a chronic disease at age 18, tended to have lower PHCS scores. After controlling for the presence of current or age 18 chronic disease, age, and sex, significant correlations were seen between PHCS scores and tobacco use, dietary habits, and exercise, but not alcohol use or frequency of medical consultation., Conclusion: This study supports the reliability and validity, and hence supports the use, of the modified Japanese PHCS. Future longitudinal research is needed to evaluate the predictive power of modified Japanese PHCS scores, to examine factors influencing the development of perceived health competence, and to assess the effects of interventions on perceived health competence.

Background: Relatively few studies have directly addressed the interaction dynamics and consequences of a companion's presence in the medical visit, and their findings have been contradictory., Objectives: To examine how patient's contribution to the medical dialogue, with or without the presence of a visit companion, is related to the perception of the medical visit as patient-centered., Design: Observational study using pre- and postvisit questionnaires and audiotape recording of medical visits., Participants: One hundred and fifty-five patients aged 65 or over; 63 in medical visits that included the presence of a companion and 82 in visits that did not include a companion., Main Outcome Measure: Patient ratings of visit patient-centeredness., Results: Long visits (greater than 10 minutes long) and visits in which patients were verbally active were rated as more patient-centered by patients than other visits. Since patients were generally less verbally active in visits that included a companion, accompanied visits, especially if they were less than 10 minutes long, received lower patient-centered ratings than others. The presence of a companion was not related to length of the visit, suggesting that the verbal activity of the companion was off-set by decreased verbal activity of the patient., Conclusions: Our results have suggested that patients are more likely to perceive their physician and visit as patient-centered when they have an opportunity to engage directly in the medical dialogue. A minimal amount of "talk-time" for patients themselves should be safeguarded even in a short visit, when a companion is present.

Although the triadic encounter of physician, patient, and an accompanying family member is a common phenomenon in geriatrics, previous research on the communication in medical encounters has primarily focused on dyadic interactions between physician and patient. This study aimed to explore the triadic communication and communication roles of patient companions in Japanese geriatric encounters. Among elderly patients aged 65 or over who were under continuous care of nine attending physicians at a university affiliated geriatric clinic in Tokyo, 63 accompanied patients and 82 unaccompanied patients were included for this study. The consultation was audiotape recorded and analyzed using the Roter Interaction Analysis System (RIAS) with additional categories developed to code aspects of companion communication. In dyadic encounters, the average proportions of physician's talk and patient's talk were 54% and 46%, respectively, while in triadic encounters the average talk proportions of physician, patient, and companion were 49%, 29%, and 22%. Companions made a significant contribution to the communication during the visit by providing information and asking the physician questions, as well as facilitating patient's talk. The companion's communication may influence not only the patient's but also the physician's communication. The patient's expectation of the companion's role during the visit and the companion's intention regarding their role were generally related to one another, and had positive associations with the companion's actual behavior during the visit. Nevertheless, companions often anticipated playing a more direct communication role during the visit, including the provision of information and asking of questions, than patients expected of them. Further investigation is needed to explore the communication dynamics in triads and dyads, and its relation to patient outcomes.

This study examines correlations between observable communicative behaviors and patient perceptions of patient-physician interaction in 86 breast cancer outpatient consultations from three patient-centered perspectives: patient participation, physician collaboration, and communicative success. Analysis relied on audio tape recordings and questionnaires, and incorporated non-behavioral factors particular to each physician, patient, and consultation. Results revealed that patient perceptions of self-participation depended on the length of consultation. Physician collaboration depended on the degree to which patients were given the opportunity to speak, while communicative success reflected a patient's level of anxiety at the time of the consultation. Yet patient perceptions of mutual participation reflected observable communicative behaviors only partially. This gap suggests that perceptual and behavioral measures reveal different aspects of participation and that the study of patient-physician interaction benefits from the inclusion of both kinds of measure.