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ObjectiveWe aimed to examine the direct effects of exposure to media information about infection-preventing behavior and its indirect effects via interpersonal communication at two time points during the pandemic.MethodsIn August 2020 and August 2021, a web-based survey of Japanese people under a declared state of emergency was conducted. We collected sociodemographic data and data on seven types of exposure to media information, three types of exposure to interpersonal communication, and six types of infection-preventing behavior.ResultsA total of 784 participants completed both surveys. Exposure to information in the mass media decreased over the year, while interpersonal communication about COVID-19-related topics increased. The direct effect of exposure to information in the media about preventive behaviors was statistically significant in the pandemic’s early stages, but this was no longer true after 1 year. The indirect effect via interpersonal communication was statistically significant at both time points.ConclusionOur results suggest that the influence of media information on infection-preventing behavior during the pandemic was maintained over time as an indirect effect via interpersonal communication. For risk communication media strategies during pandemics, adopting strategies to generate interpersonal communication will have a sustained effect on preventive behavior.

BackgroundOver the past 2 years, researchers have used various medical licensing examinations to test whether ChatGPT (OpenAI) possesses accurate medical knowledge. The performance of each version of ChatGPT on the medical licensing examination in multiple environments showed remarkable differences. At this stage, there is still a lack of a comprehensive understanding of the variability in ChatGPT’s performance on different medical licensing examinations. ObjectiveIn this study, we reviewed all studies on ChatGPT performance in medical licensing examinations up to March 2024. This review aims to contribute to the evolving discourse on artificial intelligence (AI) in medical education by providing a comprehensive analysis of the performance of ChatGPT in various environments. The insights gained from this systematic review will guide educators, policymakers, and technical experts to effectively and judiciously use AI in medical education. MethodsWe searched the literature published between January 1, 2022, and March 29, 2024, by searching query strings in Web of Science, PubMed, and Scopus. Two authors screened the literature according to the inclusion and exclusion criteria, extracted data, and independently assessed the quality of the literature concerning Quality Assessment of Diagnostic Accuracy Studies-2. We conducted both qualitative and quantitative analyses. ResultsA total of 45 studies on the performance of different versions of ChatGPT in medical licensing examinations were included in this study. GPT-4 achieved an overall accuracy rate of 81% (95% CI 78-84; P

BackgroundGovernments and public health agencies worldwide experienced difficulties with social media–mediated infodemics on the internet during the COVID-19 pandemic. Existing public health crisis communication strategies need to be updated. However, crisis communication experiences of governments and public health agencies worldwide during the COVID-19 pandemic have not been systematically compiled, necessitating updated crisis communication strategies. ObjectiveThis systematic review aims to collect and organize the crisis communication experiences of senders (ie, governments and public health agencies) during the COVID-19 pandemic. Our focus is on exploring the difficulties that governments and public health agencies experienced, best practices in crisis communication by governments and public health agencies during the COVID-19 pandemic in times of infodemic, and challenges that should be overcome in future public health crises. MethodsWe plan to begin the literature search on May 1, 2024. We will search PubMed, MEDLINE, CINAHL, PsycINFO, PsycARTICLES, Communication Abstracts, and Web of Science. We will filter our database searches to search from the year 2020 and beyond. We will use a combination of keywords by referring to the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) tool to search the abstracts in databases. We intend to include qualitative studies on crisis communication by governments and public health agencies (eg, officials, staff, health professionals, and researchers) to the public. Quantitative data–based studies will be excluded. Only papers written in English will be included. Data on study characteristics, study aim, participant characteristics, methodology, theoretical framework, object of crisis communication, and key results will be extracted. The methodological quality of eligible studies will be assessed using the Joanna Briggs Institute critical appraisal checklist for qualitative research. A total of 2 independent reviewers will share responsibility for screening publications, data extraction, and quality assessment. Disagreement will be resolved through discussion, and the third reviewer will be consulted, if necessary. The findings will be summarized in a table and a conceptual diagram and synthesized in a descriptive and narrative review. ResultsThe results will be systematically integrated and presented in a way that corresponds to our research objectives and interests. We expect the results of this review to be submitted for publication by the end of 2024. ConclusionsTo our knowledge, this will be the first systematic review of the experiences of governments and public health agencies regarding their crisis communication to the public during the COVID-19 pandemic. This review will contribute to the future improvement of the guidelines for crisis communication by governments and public health agencies to the public. Trial RegistrationPROSPERO CRD42024528975; https://tinyurl.com/4fjmd8te International Registered Report Identifier (IRRID)PRR1-10.2196/58040

BackgroundManagement and prevention of hypertension are important public health issues. Healthy dietary habits are one of the modifiable factors. As Twitter (subsequently rebranded X) is a digital platform that can influence public eating behavior, there is a knowledge gap regarding the information about foods and nutrients recommended for blood pressure control and who disseminates them on Twitter. ObjectiveThis study aimed to investigate the nature of the information people are exposed to on Twitter regarding nutrients and foods for blood pressure control. MethodsA total of 147,898 Japanese tweets were extracted from January 1, 2022, to December 31, 2022. The final sample of 2347 tweets with at least 1 retweet was manually coded into categories of food groups, nutrients, user characteristics, and themes. The number and percentage of tweets, retweets, and themes in each category were calculated. ResultsOf the 2347 tweets, 80% (n=1877) of tweets mentioned foods, which were categorized into 17 different food groups. Seasonings and spices, including salt, were most frequently mentioned (1356/1877, 72.2%). This was followed by vegetable and fruit groups. The 15 kinds of nutrients were mentioned in 1566 tweets, with sodium being the largest proportion at 83.1% (n=1301), followed by potassium at 8.4% (n=132). There was misinformation regarding salt intake for hypertension, accounting for 40.8% (n=531) of tweets referring to salt, including recommendations for salt intake to lower blood pressure. In total, 75% (n=21) of tweets from “doctors” mentioned salt reduction is effective for hypertension control, while 31.1% (n=74) of tweets from “health, losing weight, and beauty-related users,” 25.9% (n=429) of tweets from “general public,” and 23.5% (n=4) tweets from “dietitian or registered dietitian” denied salt reduction for hypertension. The antisalt reduction tweets accounted for 31.5% (n=106) of the most disseminated tweets related to nutrients and foods for blood pressure control. ConclusionsThe large number of tweets in this study indicates a high interest in nutrients and foods for blood pressure control. Misinformation asserting antisalt reduction was posted primarily by the general public and self-proclaimed health experts. The number of tweets from nutritionists, registered dietitians, and doctors who were expected to correct misinformation and promote salt reduction was relatively low, and their messages were not always positive toward salt reduction. There is a need for communication strategies to combat misinformation, promote correct information on salt reduction, and train health care professionals to effectively communicate evidence-based information on this topic.

Abstract Objective In Japan, educational materials on the home care of coronavirus disease 2019 (COVID-19) were developed owing to limited access to medical care during the pandemic. This study quantitatively evaluated the understandability, actionability, natural flow, and readability of 87 materials published by local governments in Japan for patients with COVID-19. Their understandability and actionability were rated using the Japanese version of the Patient Education Material Evaluation Tool for Printed Materials (PEMAT-P). Natural flow and readability were rated using Global Quality Score (GQS) and jReadability, respectively. Results Of the 87 materials, 55 (62.1%) were understandable and 33 (37.9%) were actionable according to the PEMAT-P. Regarding understandability, the materials used medical terms without providing definitions and lacked summaries. Regarding actionability, the materials did not demonstrate explicit steps or utilize visual aids to help the readers take action. The mean (SD) of GQS was 3.44 (0.98), indicating a moderate level of naturalness and comprehensiveness of the materials. The mean (SD) score for readability was 2.4 (0.6), indicating a “lower advanced” level. However, challenges regarding the materials’ plain language remained, such as defining medical terms, summarizing the content for understandability, and using charts and tables that encourage patients to act.

Knowledge of the contributing factors of infertility is essential to optimizing the reproductive health of the population. Magazines are a major source of informational health messages; this study quantitatively and inductively examined the information in Japanese fertility-related magazine articles on modifiable lifestyle and risk factors associated with fertility. We conducted a content analysis in two major fertility-related magazines published between 2014 and 2020 that individuals attempting to conceive were likely to read. We also identified evidence-based lifestyle factors associated with reduced fertility after reviewing the scientific literature. In total, 76 lifestyle factors were mentioned in the magazine articles. A total of 9 of these 10 evidence-based lifestyle risk factors were among the 20 factors most frequently mentioned. Thus, the evidence-based lifestyle factors were well-discussed, but the articles focused heavily on nutritional factors. Health check-ups were not covered as extensively as nutrition and diet, although physical examination can uncover physiological causes of infertility. Some lifestyle factors in the articles had not been sufficiently scientifically examined. Too many recommendations were given in the magazine articles. This may induce a feeling of being overwhelmed in readers. The publishers of magazines should provide balanced information, consider prioritizing lifestyle factors by conclusive scientific evidence, and disseminate accurate information.

There are growing concerns in Japanese workplaces that many employees do not follow recommendations to visit medical institutions for further examinations following annual health checkups. Although previous studies have shown that job- and health-related factors affect adherence to such recommendations, these longitudinal associations are unknown. We examined the longitudinal associations between job- and health-related factors and visiting medical institutions after annual health checkups among Japanese employees. We conducted a prospective cohort study in a food-related company in fiscal year 2019. Participants completed a self-administered questionnaire to assess job- and health-related factors. Of 2914 employees who completed the questionnaire, 615 received recommendations to visit medical institutions following annual health checkups in fiscal year 2020; these employees comprised our sample. We used logistic regression analysis to examine the associations between each factor and medical institution visits. Of participants, 474 (77.1 %) were men, 432 (70.2 %) were aged over 40 years, and 293 (47.6 %) visited a medical institution. Logistic regression analysis showed that participants with a primary doctor and those with obesity were more likely to visit medical institutions. In Japanese workplaces, having a primary doctor may be important in increasing adherence to medical visit recommendations following annual health checkups. However, more focus is also needed on employees without obesity who may be more confident about their health and so less likely to follow recommendations. Further intervention studies focusing on these factors are needed to identify effective interventions to improve adherence to medical recommendations.

Objective: This study reviewed studies of the anticipated affect related with COVID-19 vaccination to understand gaps in currently available studies and practice implications. Methods: We systematically searched MEDLINE, CINAHL, and other multiple databases for English language articles of studies that investigated COVID-19 vaccination related anticipated affects. Results: We identified seventeen studies. Thirteen studies focused anticipated regret from inaction (i.e., not vaccinated). Other studies focused anticipated regret from action (i.e., vaccinated), guilt from inaction, pride from action, and positive feelings from action. Eleven studies showed that anticipated regret from inaction was significantly associated with COVID-19 vaccination behavior or intention. Three of the 11 studies showed that anticipated regret from inaction was more strongly associated with vaccination behavior or intention than cognitive belief. Conclusion: Most studies showed that positive associations between anticipated regret and COVID-19 vaccination outcomes. The use of messages that target cognitive beliefs as well as those that appeal to anticipated affect may be effective to promote COVID-19 vaccination. However, most studies employed a cross-sectional design and examined negative affect. Future studies should adopt an experimental design as well as examine positive affect.

Support needs for pregnancy-related anxiety among low-risk pregnant women remain unclear. This study aimed to clarify the kinds of support for anxiety that women seek during pregnancy in Japan. Data were collected in a semi-structured focus group interview involving five pregnant women who were not in specific risk groups, recruited from three facilities in Tokyo. We generated themes using inductive thematic analysis. This paper adhered to the consolidated criteria for reporting qualitative research. From the data on support needs for anxiety during pregnancy, three themes were derived: (1) seeking tailored professional support; (2) seeking continuous support within informal relationships; and (3) seeking others’ success stories in the same situation. These three types of support gave participants a sense of reassurance or raised concern, depending on the situation. We proposed a model comprising the three derived themes using social cognitive theory. We discussed how these three types of support influenced pregnant women’s self-efficacy, which is the core concept of the social cognitive theory. Our findings may help to plan theory-based research and effective interventions to provide support for women’s anxiety during pregnancy using a population approach. Our results also demonstrated the importance of collaboration with pregnant women in developing further research and interventions.

Abstract Background Empathy for patients is now internationally accepted as one of the competencies of physicians for patient-centered medical practice and an essential component of medical education. Recently, “patient storytelling” has attracted attention in empathy education for medical students to understand patients’ experiences, feelings, and perspectives. This study aimed to quantitatively evaluate how patient storytelling enhanced undergraduate medical students’ empathy in Japan to the extent that they sustained it for six months. Methods Participants were 159 fourth-year undergraduate medical students in Tokyo in academic years 2018 and 2019. The questionnaire surveys were conducted three times: at the beginning of the class, immediately after the class, and six months after the class. The Japanese version of the Jefferson Scale of Empathy-Student Version was used in this study. Gender, age, and clinical orientation were also obtained through the self-reported questionnaire. We invited a male patient storyteller who was diagnosed with chronic kidney disease to the classes on “Professionalism.” The title of his storytelling was “The Power of Medical Professionals’ Words.” Results JSE-S scores improved significantly immediately after listening to patient storytelling. The scores remained improved six months after the class. Interest of specialty was significantly positively associated with an immediate change in JSE-S scores. However, gender had no significant association with changes in JSE-S scores either immediately or six months after education. Conclusions Our findings may suggest that patient storytelling would be useful to cultivate empathy among undergraduate medical students. It is to be expected that more medical schools will use patient storytelling to educate medical students in humanistic and communication education.

Abstract Background Alcohol use is a serious public health challenge worldwide. Japan has no government regulations or legal penalties against advertising alcoholic beverages on television (TV). Instead, advertisements depend on the Japanese alcohol industry’s self-regulation on airtime (no advertisements from 5 am to 6 pm) and the content of alcoholic beverages, which must not tempt minors. However, many adolescents (10 to 19 years old) watch TV from 6 pm to 11 pm. The aim of this study was to describe the pattern in the advertising of alcoholic beverages and alcohol-flavoured non-alcoholic beverages (AFNAB) in Japan during the popular TV viewing time for adolescents. Methods A secondary analysis of advertising airtime data from five free-to-air Japanese TV networks in the Greater Tokyo area that aired between 12 August and 3 November 2019, was performed. Results During the study period, 5215 advertisements for alcoholic beverages and AFNABs aired (1451.75 min). In total, 2303 advertisements (44.2%) were beer, low-malt beer, or beer-taste beverages, 277 (5.3%) were whisky, 2334 (44.8%) were local alcoholic beverages (shochu and seishu), and 301 (5.8%) were AFNAB. On average, more advertisements aired on weekends (67.6 advertisements) than on weekdays (59.3 advertisements) per day. Approximately 30% of advertisements for AFNABs were aired during the time restricted for alcohol advertising, although AFNABs are considered alcohol according to industry guidelines. During the popular television viewing time for young adolescents, about two to three times more advertisements were aired per hour than during the rest of the day, on both weekdays and weekends (p

Abstract Background During the coronavirus disease 2019 (COVID-19) pandemic, the importance of health literacy (HL) was addressed by public health researchers. We longitudinally examined the changes in general HL and health-related quality of life (HRQOL) between immediately before the COVID-19 outbreak and 1 year later, and how general HL before the outbreak was related to changes in HRQOL in the Japanese general population. Methods Among the Japanese residents aged 20–79 years who participated in our previous study in 2017, 826 were followed-up via self-administered questionnaires in January 2020 and February 2021, for the purposes of this study. The HRQOL was measured using the SF-8, a short version of the SF-36 Health Survey, and general HL was measured using the short form of the European Health Literacy Survey Questionnaire (HL-SF12) in the 2020 and 2021 surveys. Results The physical and mental dimensions of HRQOL as well as general HL declined significantly from immediately before the COVID-19 outbreak to 1 year later (p = .010, p

Tools to evaluate pregnancy-specific anxiety are lacking in Japan. This study aimed to develop a Japanese version of the Pregnancy-Related Anxiety Questionnaire—Revised-2. After scale translation and cognitive interviews, we conducted a cross-sectional study among 120 ≥18-year-old, singleton (pregnant with one baby) Japanese women before 15 weeks of pregnancy, recruited from four facilities. A total of 112 women completed the questionnaires. We tested the internal consistency, measurement error and reliability, structural validity, measurement invariance across nulliparous and parous women, construct validity by calculating omega, standard error of measurement (SEM), intraclass correlation coefficient (ICC), confirmatory factor analysis (CFA), multigroup CFA, multitrait-scaling analysis, correlational analyses with other measurements, and t-test to compare nulliparous and parous groups. Omega was 0.90 for the total score. SEM was 3.4 and ICC was 0.76. The CFA revealed an optimal fit for the three-factor model based on the original scale. Multigroup CFA supported measurement invariance across the nulliparous and parous groups, and multitrait-scaling analysis revealed 100% scaling success. The correlation coefficients with other scales of childbirth anxiety and general anxiety were 0.70 and 0.24. The mean total score of the nulliparous women was higher than that of the parous women (34.5 vs. 30.3, p = 0.001). Therefore, the scale was determined to have good validity and reliability.

The introduction of an evolutionary perspective into public health research has received attention in recent years. We aimed to examine the effects of messages that target the fundamental human motive of kin care (i.e., childbirth and parenting) on cervical cancer screening recommendations, based on an evolutionary theoretical approach. A randomized controlled study was conducted in Japan. Female participants (n = 969) were randomly assigned either to a group that received an intervention message that targeted the fundamental motive of kin care (recommending cervical cancer screening for future childbearing), or that targeted the fundamental motive of disease avoidance, or a control message. Intention to obtain cervical cancer screening was assessed both before and after reading the messages. A one-way ANOVA with Tukey’s or Games–Howell test was conducted. Each of the intervention message targeting the fundamental motive of kin care and of the message targeting disease avoidance significantly increased intention to obtain cervical cancer screening versus a control message (M = 0.76 vs. M = 0.17, p

Introduction Various cognitive behavioural models and theories have been used to address vaccine hesitancy. However, those models and theories have been criticised for focusing on cognitive influences on health behaviours at the expense of affective influences. Recent studies have highlighted the importance of affective elements as complementary predictors of health behaviours. Anticipated affect (ie, an expectation of one’s affective response to the target behaviour) has received the most scrutiny. This scoping review will analyse studies of anticipated affect that aimed to encourage vaccination and organise implications for future research and practice in vaccine communication. Our report will focus on exploring the usefulness of affective influence in terms of a comparison with the cognitive influence on vaccination.Methods and analysis We will search several databases (MEDLINE, CINAHL, PsycINFO, PsycARTICLES, Academic Search Complete, Embase, Scopus, Web of Science and Google Scholar) and identify additional literature by searching the reference lists of eligible studies. Eligible studies are those that quantitatively or qualitatively examined anticipated affect and aimed to encourage vaccination. Only papers written in English will be included. We will include all eligible publications from database inception up to the date of the final database search. Two independent reviewers will screen the titles, abstracts and full texts of all identified studies. Two independent reviewers will share responsibility for data extraction and verification. Discrepancies will be resolved through discussion to reach consensus. We will extract data such as study characteristics, type of vaccine, type of anticipated affect, participant characteristics, methodology and main results. Data will be extracted using a customised extraction template on Covidence. The findings will be synthesised in a descriptive, narrative review.Ethics and dissemination This work does not warrant any ethical or safety review. This scoping review will be presented at a relevant conference and published in a peer-reviewed journal.

Introduction Vaccine hesitancy is a global problem, impeding uptake of vaccines against measles, mumps, and rubella and those against human papillomavirus and COVID-19. Effective communication strategy is needed to address vaccine hesitancy. To guide the development of research in the field and the development of effective strategies for vaccine communication, this scoping review aims to analyse studies of interventions using narrative to encourage vaccination.Methods and analysis We will search the following databases: MEDLINE, CINAHL, PsycINFO and PsycARTICLES. We will identify additional literature by searching the reference lists of eligible studies. Eligible studies will be those that quantitatively examined the persuasiveness of narrative to encourage vaccination. Two independent reviewers will screen the titles, abstracts and full texts of all studies identified. Two independent reviewers will share the responsibility for data extraction and verification. Discrepancies will be resolved through consensus. Data such as study characteristics, participant characteristics, methodology, main results and theoretical foundation will be extracted. The findings will be synthesised in a descriptive and a narrative review.Ethics and dissemination This work does not warrant any ethical or safety concerns. This scoping review will be presented at a relevant conference and published in a peer-reviewed journal.

We examined the association between COVID-19 vaccination behavior and trust in COVID-19-related information sources during the initial period of COVID-19 vaccination in Japan. A cross-sectional survey was conducted in August 2021, 5 months after the start of COVID-19 vaccination for the general public under emergency approval. Participants were recruited using non-probability quota sampling from among Japanese residents who were under a declared state of emergency. Sociodemographic data, vaccination behavior, and levels of trust in eight media sources of information and three interpersonal information sources were assessed using an online survey form. A total of 784 participants completed the survey. The results of multiple logistic regression analysis showed that age, household income, underlying medical conditions, and living with family were significantly associated with COVID-19 vaccination behavior. Regarding COVID-19 vaccine information sources, trust in public health experts as a source of media information and primary care physicians as a source of interpersonal information showed significantly positive associations with COVID-19 vaccination behavior (odds ratio [OR] = 1.157, 95% confidence interval [CI] 1.017–1.31; OR = 1.076; 95% CI 1.006–1.150, respectively). Increasing trust in public health experts and primary care physicians and disseminating vaccine information from these sources will help promote vaccination under emergency approval.

We reviewed studies that examined the anticipated affects associated with human papillomavirus (HPV) vaccination to identify gaps in the literature and the currently available practice implications for encouraging HPV vaccination. We systematically searched MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, PsycArticles, Academic Search Complete, Scopus, and Web of Science to find English articles that quantitatively and qualitatively examined anticipated affects associated with HPV vaccination. A total of twenty-one studies were identified. Seventeen studies examined the anticipated inaction regret (i.e., not being vaccinated). Most of the included studies reported that anticipated inaction regret had a significantly positive association with HPV vaccination outcomes, such as vaccination behavior, intention, willingness, and acceptability. Furthermore, seven studies reported that anticipated inaction regret had a significantly positive and stronger association with vaccination outcomes than cognitive beliefs, such as vaccine effectiveness and safety, and perceived susceptibility and severity. The present review indicated that the stronger the participants’ anticipated inaction regret, the more likely they were to receive the HPV vaccine. Messages targeting the anticipated affect may be as effective as or more effective than messages targeting cognitive beliefs in encouraging HPV vaccination among people. However, most of the studies included in the present review adopted a cross-sectional design with vaccination intention and willingness as outcomes. Therefore, future studies should examine the influence of anticipated affects on the utilization of HPV vaccines using experimental designs to accumulate stronger evidence.

Physical activity has significant health benefits for the heart, body, and mind. However, the percentage of people engaging in exercise routines is low in Japan. Goals are important components of motivation. Scholars suggest that appropriately setting both subordinate goals of what to do and superordinate goals of why to do it may motivate the audience and promote behavior. However, it is not known what goals are presented in print materials that promote physical activity. Therefore, this study aimed to understand the presented goals by performing content analysis of those materials in Japan. We collected print materials such as leaflets, brochures, and posters via website search. The presence of subordinate and superordinate goals and topics for each goal was analyzed. A total of 224 print materials were systematically collected and analyzed. The results showed that 14.3% of the print materials did not present any superordinate goals, whereas 100% of them presented subordinate goals. For superordinate goals, healthy aging was frequently presented. For subordinate goals, 67.4% presented only exercise. There is a difference in presenting goals between the private and government sectors. Since goals affect motivation and behavior change, it may be beneficial to incorporate the findings of the goal theory in future print materials.

Objectives: Patients often consent to participate in cancer clinical trials despite misunderstanding the trial content. We developed a tablet-based clinical trial decision aid and tested its use with the usual discussion at the time of clinical trial registration. Methods: Participants were individuals considering participating in a breast cancer clinical trial. The control participated in usual discussions; the intervention group participated in discussion using the decision aid. Pre- and post-discussion, we investigated knowledge, decision-making conflict, and discussion length. Results: We enrolled 54 patients, 27 in the control group and 27 in the intervention group. Post-discussion clinical trial knowledge was significantly higher in the intervention group than in the control group (p = 0.003). No significant difference was found in decisional conflict, but the intervention group tended to have lower post-discussion conflict than the control group. There was no between-group difference in the length of discussions with physicians and clinical research coordinators. Conclusion: For women considering participation in cancer clinical trials, a tablet-based decision aid may promote clinical trial understanding without increasing discussion length or patient burden. This pre-learning decision aid incorporating a quiz and bidirectional question prompt lists may improve participants’ understanding of clinical trials.

Objectives: The number of home-dwelling elderly people who need drug treatment is increasing with the aging of the population. Elderly people are often suffering from various chronic diseases requiring treatment with multiple drugs, which makes self-care at home difficult. This study focused on medication adherence and aimed to identify the current state of self-care for drug treatment in home-dwelling elderly people and the factors that relate to self-care and medication. Study design: Cross-sectional study. Methods: Medication adherence was measured on a 12-item medication adherence scale for home-dwelling elderly people aged 65 and over who were taking medications. The present condition of medication self-care for home-dwelling elderly people was clarified in terms of medication adherence. Next, we clarified the relationship between medication adherence and other factors such as demographic and clinical characteristics, communication with doctors, and health literacy. Results: The average age was 73.7 (47.2% male). Functional health literacy and communicative health literacy were significantly associated with a high level of medication adherence. There was also a significant association between medication adherence and good communication with doctors. Conclusions: Medication adherence among home-dwelling elderly people was found to be related to the ability to obtain, understand, and communicate information, in addition to the basic literacy skills of health literacy. We also found that good communication with doctors was closely related to medication adherence. Our findings suggest that it is necessary to be consciously involved in promoting health literacy and communication when supporting self-care for medical treatment of home-dwelling elderly people in the future.

Objectives Public health institutions have alerted consumers about advertising for dietary supplements with false claims of preventing or treating COVID-19. We quantitatively and qualitatively examined newspaper advertisements for dietary supplements before and after the COVID-19 spread.Design Content analysis.Participants We analysed advertisements for dietary supplements in two major Japanese newspapers in February–July 2019 and February–July 2020. Our analysis covered 2167 advertisements.Results The number of advertisements for dietary supplements that claimed to be effective in infection prevention (p=0.009) and improving joint (p=0.002) and digestive functions (p=0.002) significantly increased after the spread of COVID-19 compared with before. Dietary supplements that claimed to be effective in preventing infection were advertised in combination with recommendations for gargling and handwashing. Such terms as ‘defence’ and ‘prevent’ were used to promote the preventive effect.Conclusions False and misleading claims in advertising for dietary supplements may result in consumer harm, such as overdosing and failure to take preventive behaviour. While the pandemic continues, there will be an increasing need for disseminating accessible information about the appropriate use of dietary supplements, consumer education and warnings to manufacturers.

The number of infertility treatment cycles in Japan is the highest worldwide. Studies have shown that stigma is a predictor of stress-related symptoms including anxiety and depression in women undergoing infertility treatment. Stress management to prevent stress-related symptoms may be crucial; however, few studies have examined the model of stigma and stress responses. Based on the stress-coping model, we hypothesized that stigma threatens the identity of such women and that coping failure increases stress responses. We aimed to explore the role of cognitive appraisals and coping strategies as mediators of the association between the stigma of infertility and stress responses. In December 2021, we conducted a cross-sectional study in Japan, in which 254 women undergoing infertility treatment completed a web-based survey. Hierarchical multiple regression analysis was conducted to analyze the associations between stigma, cognitive appraisals, coping strategies, and stress responses. The results showed that explanatory power increased with each additional variable in the following order: stigma, cognitive appraisals, and coping. Participants with a high level of stigma evaluated it as threatening, and used self-blame and venting coping strategies, and showed higher stress responses. Conversely, participants who used positive reframing coping strategies exhibited lower stress responses. Based on this, effective strategies to address stigma and stress responses are necessitated.

BackgroundThe changing pattern of anxiety and stress experienced by pregnant women during the COVID-19 pandemic is unknown. ObjectiveWe aimed to examine the sources of anxiety and stress in pregnant women in Japan during the COVID-19 pandemic. MethodsWe performed content analysis of 1000 questions posted on the largest social website in Japan (Yahoo! Chiebukuro) from January 1 to May 25, 2020 (end date of the national state of emergency). The Gwet AC1 coefficient was used to verify interrater reliability. ResultsA total 12 categories were identified. Throughout the study period, anxiety related to going outdoors appeared most frequent, followed by anxiety regarding employment and infection among family and friends. Following the declaration of the state of national emergency at the peak of the infection, infection-related anxiety decreased, whereas anxiety about social support and mood disorders increased. Stress regarding relationships appeared frequent throughout the pandemic. ConclusionsThe sources of anxiety and stress in pregnant women in Japan changed during the pandemic. Our results suggest the need for rapid communications in the early phase of a pandemic as well as long-term psychosocial support to provide optimal support to pregnant women in Japan. Health care professionals should understand the changing pattern of requirements among pregnant women.

We have taught writing for public health to students completing a Master of Public Health since 2016 in Japan. We adopted a writing-to-learn approach and assigned work to students to write health materials that encourage recipients to perform health behaviors (eg, drafting a poster to encourage lay audiences to adopt preventive behaviors during the COVID-19 pandemic). We collected students’ work assignments and products from 2016 to 2020 and reviewed them to identify distinctive trends common to all years. We found that there was a curse of knowledge (ie, difficulties to imagine the state of mind of not knowing when knowing something) among students. Students strongly embraced the adage “knowledge is power” and underestimated the difficulties lay audiences face. Their writing was somewhat dogmatic, whereby experts imparted privileged knowledge to ignorant non-experts. However, it is well known that merely imparting knowledge often does not work to educate lay audiences about making better decisions. Debiasing this curse of knowledge among students will be the main target of our writing education.

Abstract Background The human papillomavirus (HPV) vaccination coverage rate has fallen sharply in Japan since 2013, when newspapers began covering negative campaigns against the vaccination. We examined and compared contents from newspaper articles before and after the start of this HPV vaccination crisis. Methods We collected articles published between January 2005 and September 2017 in the four daily national Japanese newspapers with the highest domestic circulation. We then conducted text mining analysis to chronologically examine content distribution. Results From among the 1178 articles analyzed, 12 types of contents were identified. Contents related to cervical cancer prevention, such as on the risk of developing cervical cancer, causes of cervical cancer, and the effects of vaccination, were frequently conveyed until 2012. However, after March 2013, they were replaced with anti-vaccination contents, such as on adverse effects to vaccines, alleged victims, and related lawsuits. Meanwhile pro-vaccination contents, such as safety statements from the World Health Organization, scarcely received coverage. Conclusions Newspaper contents changed profoundly before and after the start of the vaccination crisis. Those newspaper reports potentially had impact on readers’ beliefs and actions. Journalists should strive for impartial coverage so readers can make more-informed decisions. Health professionals should be expected to work with journalists to help improve impartiality in newspaper coverage. The Ministry of Health, Labour and Welfare should discus benefits and risks of the HPV vaccination based on the scientific evidences, and consider to resume the proactive recommendation of HPV vaccination. Well-organized advocacy among medical societies, scientists and health professionals will also be needed to influence the government.

Japan has the highest number of cases of infertility treatment in the world. Studies have indicated that women undergoing infertility treatment feel stigmatized and suffer from psychological symptoms such as anxiety and depression. However, in Japan, few studies have quantitatively examined the association between the stigma of infertility and psychological symptoms, and, to our knowledge, no study has examined its association using a scale with tested reliability and validity. This study aims to quantitatively examine the relationship between infertility stigma and anxiety, depression, and psychological distress among women undergoing infertility treatment, using a scale that has been validated for reliability and validity. The cross-sectional study was conducted in December 2021 through a web-based survey of 254 participants undergoing infertility treatment. A multiple regression analysis was performed to examine the relationship between stigma and anxiety, depression, and psychological distress. Stigma was a statistically significant predictor of anxiety, depression, and psychological distress (standardized β = 0.58, p < 0.001; β = 0.50, p < 0.001; β = 0.62, p < 0.001, respectively) after controlling for sociodemographic and infertility characteristics. Future studies should examine the causal relationship between stigma and anxiety, depression, and psychological distress and how to intervene to reduce stigma among women undergoing infertility treatment.

The provision of information about cancer is an important aspect of cancer care. Cancer information provided online is expected to meet the needs of information seekers. Whether information needs vary according to tumor site is largely unknown. We aimed to examine similarities and differences in informational needs by cancer type. Data were collected using a questionnaire administered on Japan's largest cancer information website, “Ganjoho service”. A total of 2782 free descriptive responses in the period from April 2012 to December 2017 were analyzed using text-mining software. We identified the top 10 informational need contents, in order of appearance frequency, for eight tumor sites: gastric, colorectal, esophageal, lung, pancreatic, breast, cervical, and prostate cancer. Frequent information needs common to all tumor sites included symptoms, disease stages, treatments, chance of cure, recovery, metastasis, and recurrence. A need for information about diet, pain, side effects of treatments, complementary and alternative medicine was frequent for some tumor sites. Tumor site-specific information should include the following, according to cancer type: information of scirrhous carcinoma for gastric cancer; unusual feces for colorectal cancer; lung X-ray images for lung cancer; early detection for pancreatic cancer; adenocarcinoma, sexual activity, pregnancy, and childbirth for cervical cancer; breast conservation or reconstruction and triple negative cancer for breast cancer; test values and diagnosis and urinary problems for prostate cancer; and hormone therapy for breast and prostate cancer. Cancer information provided online should meet these frequent informational needs, considering similarities and differences of the information required according to tumor site. Keywords: Cancer, Neoplasms, Consumer health information, Information services, Information dissemination, Information seeking behavior, Cancer patients, Cancer survivors, Health communication

Vaccine hesitancy is a problem attracting growing attention and concern. In this paper, we discuss why anti-vaccination messages are influential and which pro-vaccine messages can be effective to address vaccine hesitancy from the perspective of dual-process theories of cognitive functioning. The functioning of the human brain can be characterized by two different types of cognitive functioning: intuitive System 1, which is evolutionarily old, fast, and automatic; and analytical System 2, which is evolutionarily recent, slow, and deliberative. Anti-vaccination messages that inspire fear activate System 1, and vaccine recommendation messages that use statistics activate System 2. System 1 has a greater influence on judgment than System 2. The processing of System 1 is called “trajectory.” Even if adequate knowledge about the effectiveness and safety of vaccination is input to System 2, vaccine hesitancy cannot be easily erased once it is generated by System 1. We suggest that vaccine recommendation messages should target System 1 in addition to System 2, to counter anti-vaccination messages and address vaccine hesitancy.

In recent years, researchers have discussed the introduction of an evolutionary perspective into public health and health behavior research. We aimed to examine the effects of messages that target the fundamental human motive of kin care on HPV vaccination recommendations among mothers with daughters, based on an evolutionary theoretical approach. This study consisted of a three-arm parallel-group single-blinded randomized controlled study. A web-based survey was conducted from 7 to 8 October 2021 in Japan. Mothers with daughters (n = 969) were randomly assigned either to a group that received an intervention message that targeted the fundamental motive of kin care, or that targeted the fundamental motive of disease avoidance, or a control message. Intention to have daughter(s) receive HPV vaccination was assessed both before and right after reading the messages. A one-way ANOVA with Tukey’s or Games–Howell test was conducted. An intervention message targeting the fundamental motive of kin care and disease avoidance significantly increased intention of vaccination versus a control message (p < 0.001, respectively). There was no significant difference between the two intervention groups. The evolutionary theoretical approach that focuses on fundamental human motives may have the potential to extend the communication strategy for HPV vaccination recommendations. Health professionals may be recommended to deliver messages that target the fundamental motive of kin care as well as messages about the susceptibility and severity of cervical cancer and vaccine efficacy (e.g., “Getting cervical cancer can prevent childbirth. To protect your daughter and your future grandchildren, get your daughter vaccinated against HPV”). However, the present study only evaluated HPV vaccination intentions in Japanese mothers with daughters. Future studies should evaluate vaccination behavior in a wider range of subjects to confirm that the evolutionary theoretical approach promotes HPV vaccination.

The stigma of infertility negatively affects health, resulting in mental distress and poor quality of life. An appropriate scale is essential to examine the stigma experienced by infertile women and provide adequate interventions. Therefore, we developed a Japanese version of the Infertility Stigma Scale (ISS). After examining the content validity of this scale, we conducted an online survey of women undergoing fertility treatment to test the scale’s structural validity, internal consistency, intra-rater reliability, known-groups validity, convergent validity, and discriminant validity. A total of 254 participants were included in the analysis. The results of confirmatory factor analysis of four factors based on the original scale revealed the optimal fit. Cronbach’s alpha was 0.95 for the total score. Concerning test–retest analysis, the total score of the ISS and subscale had a high Spearman correlation coefficient (ρ = 0.61–0.88, p < 0.001). For convergent validity, the association between the ISS and social support, self-esteem, and family functioning was significantly negatively correlated. The results of the multitrait scaling analysis scale showed that correlations of all items exceeded 0.40, and scaling errors (7/81, 8.6%) were few. The Japanese version of the ISS was confirmed to have acceptable reliability and validity.

Previous content analysis of video advertisements for functional foods identified “Exemption” advertisements. “Exemption” advertisements may imply to the audiences that “By taking functional foods, I can adopt unhealthy behaviors or I don’t have to adopt healthy behaviors”. In the context of Compensatory Health Beliefs (CHBs), this study refers to these beliefs as functional foods related to CHBs (FF-CHBs). This study aimed to assess the effects of exposure to “Exemption” advertisements for fat-reduction functional foods on audiences. The main hypothesis is exposure to “Exemption” video advertisements increases participants’ FF-CHBs. Participants (n = 788) were randomly assigned to an intervention group that viewed three video advertisements or a control group and answered online self-administered questionnaires. Intervention videos were three videos with the highest number of views per month from among the “Exemption” video advertisements. Control videos were about how to brew green tea. FF-CHBs was assessed before and after the intervention. The intervention group showed significantly greater FF-CHBs after intervention (mean = 2.37 vs. 2.11, p < 0.001, η2 = 0.026) compared with the control group. “Exemption” functional foods video advertisements increased FF-CHBs that can lead to adopting unhealthy behaviors and avoiding healthy behaviors. The content of these functional foods video advertisements should be improved to promote public health.

We investigated the relationship of processing fluency of written information about exercise to participants’ perceived interest, safety, self-efficacy, outcome expectation, and behavioral intention regarding the exercise. We randomly assigned 400 men and women aged 40–69 years to control or intervention conditions. Perceived self-efficacy of performing the exercise in the intervention group (i.e. easy to read) was significantly higher than that in the control group (i.e. difficult to read) ( p = 0.04). Easy-to-read written health information may be important not only for making written health information comprehensible but also for increasing readers’ self-efficacy for adopting health-related behaviors.

Abstract 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 Background Patient-centered care has been one of the most frequently discussed principles in medical practice. However, there is a serious concern that the patient-centered attitudes of physicians diminish over the course of their medical education. This longitudinal study examined changes in resident physicians’ patient-centered attitudes and their confidence in communicating with patients, and explored the relationship between the two traits. Methods The study participants were resident physicians at a university hospital in Tokyo. Participants’ patient-centered attitudes (as measured by the Patient–Practitioner Orientation Scale [PPOS]), and their confidence in communicating with patients (as per the Physician Confidence in the Medical Interview scale: [PCMI]) were assessed through self-reported questionnaires completed at the beginning of residency (n = 204) and again at the end of the first year (n = 95). Results PPOS scores declined significantly during the year, both in terms of attitude toward sharing information and decision-making with patients, and attitude of caring for patients’ expectations and emotions. The shift in caring attitude differed significantly by gender. The increase in PCMI score was greater for those with a smaller decrease in PPOS score. Conclusions As seen in previous studies of medical students, resident physicians’ patient-centered attitudes declined during their first year of residency, while there may be a gender-based difference within the shift. The increase in physicians’ confidence in communicating with patients was greater for those who showed a smaller decline in patient-centered attitude. Additional studies are needed to detail the changes in physicians’ attitudes, confidence, and communication skills over the course of their medical training, and to develop systematic assessment and training programs.

It is important to provide information on HPV vaccination and on early detection and early treatment for cervical cancer. Readability is a key aspect in the success of cancer communication using written health information. We reviewed studies assessing the readability of information on HPV vaccination and cervical cancer. We conducted a systematic literature search in June 2021 using four online databases (Medline, CINAHL, PsycArticles, and PsycINFO). Studies that assessed the readability level of online and offline information regarding HPV vaccination and cervical cancer were included in the review. Twelve articles were deemed fit for study inclusion. Our results showed that most of the materials assessed were difficult to read and higher than eighth-grade reading level. Few of the materials assessed were at the recommended grade 5–6 level or below. Readability assessments of HPV vaccination and cervical cancer information are scarce. Additional studies on the readability of information regarding HPV vaccination and cervical cancer are recommended. Health professionals should develop health information on HPV vaccination and cervical cancer that is easy to read.

Dietary supplements are widely advertised and the market is expanding worldwide. Research suggests that dietary supplement advertising may lead consumers to make inappropriate health-related decisions, to express behaviors such as overdosing, and to neglect healthy lifestyle behaviors. We conducted a content analysis of video advertisements for dietary supplements and described the content of advertisements with high numbers and frequent views. We analyzed 82 video advertisements on YouTube that promoted fat-reduction effects. We extracted 22 themes and classified them into 10 categories. The categories with the highest numbers of advertisements were “Exemption” (i.e., consuming the product frees the audience from refraining from binge eating) (20 ads, 24.4%) and “Health Concerns” (i.e., the product intake solves the health concerns of the audience) (19 ads, 23.2%). These advertisements may stimulate negative audience attitudes toward appropriate health behaviors. The category with the most frequent views was “Lifestyle” (i.e., adding product intake to a healthy lifestyle) (3,035,298 views). “Lifestyle” advertisements portray physical activity in a positive light and may promote appropriate health behaviors in the audience. We discuss the possible effects of the advertisements on audiences and consider issues for future research and practice.

Historically, anti-vaccination sentiment has existed in many populations. Mass media plays a large role in disseminating and sensationalizing vaccine objections, especially via the medium of the Internet. Based on studies of processing fluency, we assumed that anti-influenza vaccination online messages to be more readable and more fluently processed than pro-influenza vaccination online messages, which may consequently sway the opinions of some audiences. The aim of this study was to compare readability of anti- and pro-influenza vaccination online messages in Japan using a measure of readability. Web searches were conducted at the end of August 2016 using two major Japanese search engines (Google.jp and Yahoo!.jp). The included websites were classified as “anti”, “pro”, or “both” depending on the claims, and “health professional” or “non-health professional” depending on the writers' expertise. Readability was determined using a validated measure of Japanese readability (the Japanese sentence difficulty discrimination system). Readability of “health professional” websites was compared with that of “non-health professional” websites, and readability of “anti” websites was compared with that of “pro” websites, using the t-test. From a total of 145 websites, the online messages written by non-health professionals were significantly easier to read than those written by health professionals (p = 0.002, Cohen's d = 0.54). Anti-influenza vaccination messages were significantly easier to read than pro-influenza vaccination messages (p

Abstract Background Health materials to promote health behaviors should be readable and generate favorable evaluations of the message. Processing fluency (the subjective experience of ease with which people process information) has been increasingly studied over the past decade. In this review, we explore effects and instantiations of processing fluency and discuss the implications for designing effective health materials. We searched seven online databases using “processing fluency” as the key word. In addition, we gathered relevant publications using reference snowballing. We included published records that were written in English and applicable to the design of health materials. Results We found 40 articles that were appropriate for inclusion. Various instantiations of fluency have a uniform effect on human judgment: fluently processed stimuli generate positive judgments (e.g., liking, confidence). Processing fluency is used to predict the effort needed for a given task; accordingly, it has an impact on willingness to undertake the task. Physical perceptual, lexical, syntactic, phonological, retrieval, and imagery fluency were found to be particularly relevant to the design of health materials. Conclusions Health-care professionals should consider the use of a perceptually fluent design, plain language, numeracy with an appropriate degree of precision, a limited number of key points, and concrete descriptions that make recipients imagine healthy behavior. Such fluently processed materials that are easy to read and understand have enhanced perspicuity and persuasiveness.

Objectives: The aim of this study is to empirically examine a full pathway model of health literacy, and health and well-being outcomes among patients with type 2 diabetes. Methods: A three-wave longitudinal survey was administered to 148 patients with diabetes. Covariance structure analysis was conducted to create a path diagram, with health literacy and burden of medical expenses included as independent variables and with psychosocial factors, behaviors, and health and well-being outcomes included as dependent variables. Results: The model fit indices showed a comparative fit index of 0.985 at baseline, 0.959 after 3 months, and 0.948 after 6 months, with a root mean square error of approximation of 0.040 at baseline, 0.079 after 3 months, and 0.085 after 6 months. There were 14 significant paths across the three time points between health literacy and understanding of diabetes care, self-efficacy, communication with doctors, and medication adherence. Conclusion: The model fitness index showed an adequate result. Health literacy was significantly positively associated with understanding of diabetes care, self-efficacy, communication with doctors, and medication adherence. Health literacy had a direct positive influence on medication adherence and possibly an indirect positive influence on exercise/diet via self-efficacy. The results were generally consistent across the three time points, suggesting good reliability of the models. Improving health literacy may lead to better self-management of diabetes and favorable health outcomes.

Many studies have explored the association between health literacy and health-care utilization; however, the majority assessed functional health literacy in terms of basic skills. Japan's health-care and medical examination system in workplaces is different from that of other major countries. This study examined the relationship of health literacy with health-care use (emergency visit, hospitalization, dental checkup, and health checkup or cancer screening); it focused on differences by occupation and health-care service utilization among general Japanese using the communicative and critical health literacy scale. We conducted a cross-sectional observational study of 1002 Japanese residents. Through a questionnaire, we investigated socioeconomic status, health status, health-care use, and health literacy. Among all participants and non-workers, logistic regression analyses revealed that health literacy was significantly associated with health checkup or cancer screening after adjusting for sex, age, marital status, education, and having a disease or disorder (adjusted odds ratio [OR] = 1.431, 95% confidence interval [CI], 1.131–1.810; adjusted OR = 1.614, 95% CI, 1.114–2.339, respectively). Among workers, we observed no significant association between health literacy and health-care utilization. These results indicate that health literacy is closely related to use of preventive health-care. Japan's health-care system in workplaces may promote use of preventive health-care services regardless of health literacy, whereas improving health literacy may be more critical among non-workers. Keywords: Health literacy, Health-care utilization, Occupation, General Japanese population

Background: Health literacy (HL) is not solely an individual skill but a distributed resource available within individual's social networks. This study explored the associations between individual and family member HL using two separate self-report measures of HL: the European Health Literacy Survey Questionnaire (HLS-EU-Q47) and the Communicative and Critical Health Literacy scale (CCHL).Methods: A self-administered questionnaire survey was conducted with 501 pairs of Japanese residents aged 30 to 79 and their family members whom they most often consulted for help with health issues. HL was measured using HLS-EU-Q47 and CCHL.Results: The HL scores of individuals and their family members were positively correlated for both measures. The correlation was stronger for the HLS-EU-Q47, presumably because it measures the perceived manageability of health-related tasks that implicitly depend on the availability of support for an individual. In contrast, the CCHL measures a single individual's perceived abilities. Both individual and family member CCHL scores were independently related to individual HLS-EU-Q47 scores, particularly when an individual had a family member with a higher CCHL score than his/her own.Conclusions: Limited individual ability to achieve health-related tasks might be compensated for by the higher ability of other family members. In addressing problems with limited health literacy, future studies should focus not only on the individual but also on people who can provide an individual with support.

We previously conducted a randomized controlled study to examine persuasive messages recommending HPV vaccination to mothers with daughters in Japan. That study showed that the three types of intervention message used (statistical information only, a patient’s narrative in addition to statistical information, and a mother’s narrative in addition to statistical information) all significantly improved mothers’ intention to have their daughter(s) receive the HPV vaccine, in comparison with mothers who received no messaging. The present study is a follow-up survey to assess the long-term effect of the intervention. Four months after the initial study, in January 2018, participants in the previous study were contacted and queried about their current intention to have their daughter(s) receive the HPV vaccine. Statistical analysis was conducted using the paired t-test and analysis of variance. A total of 978 mothers participated in the current survey. Vaccination intention 4 months after intervention had decreased to a level that did not differ significantly from the level prior to intervention in all three intervention conditions. The amount of change in vaccination intention 4 months after intervention did not differ significantly among the three intervention groups (p = 0.871). A single exposure to messaging was insufficient to produce a persistent intervention effect.

During the COVID-19 pandemic, a social lockdown should be put in place and individuals should stay at home. Behavioral change is the only way to prevent the pandemic and overwhelmed healthcare systems until vaccines are available. We aimed to examine the psychological factors that predict staying at home during the COVID-19 pandemic and social lockdown. A total of 1980 participants in Japan completed a survey for this study from 9 to 11 May 2020, when the state of emergency covered all prefectures in the country. Self-reported behavior in terms of staying at home, the perceived severity of the pandemic, vulnerability to the pandemic, response efficacy, and self-efficacy based on protection motivation theory were assessed. Multiple regression analysis showed that perceived severity (standardized β = 0.11, p < 0.001) and self-efficacy (standardized β = 0.32, p < 0.001) significantly predicted greater levels of staying at home, after controlling for socio-demographics. However, perceived vulnerability and response efficacy did not. To encourage people to stay at home during the pandemic and social lockdown, increasing the perceived severity of infection by COVID-19 and self-efficacy in terms of exercising restraint with respect to going out may consequently encourage people to stay at home.

BackgroundThe human papillomavirus (HPV) vaccination percentage among age-eligible girls in Japan is only in the single digits. This signals the need for effective vaccine communication tactics. This study aimed to examine the influence of statistical data and narrative HPV vaccination recommendation massages on recipients’ vaccination intentions.MethodsThis randomized controlled study covered 1,432 mothers who had daughters aged 12–16 years. It compared message persuasiveness among four conditions: statistical messages only; narrative messages of a patient who experienced cervical cancer, in addition to statistical messages; narrative messages of a mother whose daughter experienced cervical cancer, in addition to statistical messages; and a control. Vaccination intentions to have one’s daughter(s) receive the HPV vaccine before and after reading intervention materials were assessed. Statistical analysis was conducted using analysis of variance with Tukey’s test or Games–Howell post hoc test, and analysis of covariance with Bonferroni correction.ResultsVaccination intentions after intervention in the three intervention conditions were higher than the control condition (p

Background: Influenza vaccine coverage among the Japanese population is less than optimal. Anti-vaccination sentiment exists worldwide, and Japan is no exception. Anti-influenza vaccination activists argue on the internet that influenza vaccine has little or no efficacy and a high risk of side effects, and they warn that people should forgo vaccination. We conducted a qualitative analysis to explore beliefs underlying the messages of anti-influenza vaccination websites, by focusing on the perceived value these beliefs provide to those who hold them. Methods: We conducted online searches in January 2017 using two major Japanese search engines (Google Japan and Yahoo! Japan). Targeted websites were classified as “pro”, “anti”, or “neutral” depending on their claims. We applied a dual analytic approach—inductive thematic analysis and deductive interpretative analysis—to textual data of the anti websites. Results: Of the 113 anti websites, we identified two themes that correspond to beliefs: it is necessary to 1) protect others against risks and exploitation related to influenza vaccination, and 2) educate others about hidden truths and self-determination. Authors of anti websites ascribed two values (people's “safety” and one's own “self-esteem”) to their beliefs. Discussion: Website authors may engage in anti-vaccination activities because they want to feel they are virtuous, saving people from harm caused by vaccination, and to boost their self-esteem, thinking “I am enlightening uninformed people.” The anti-vaccination beliefs of website authors were considered to be strong. In promoting vaccination, it would be better not to target outright vaccine refusers, such as the authors of anti-vaccination websites; it is preferable to target vaccine-hesitant people who are more amenable to changing their attitudes toward vaccination. We discuss possible means of promoting vaccination in that target population.

On 16 August 2017, the Minamata Convention on Mercury entered into force to protect human health and the environment from the adverse effects of mercury. Minamata disease is caused by methylmercury poisoning in humans. The victims’ acute symptoms were captured in photographs by Eugene Smith by which people worldwide became aware of this environmental health crisis. Over 60 years have passed since the first case of methylmercury poisoning. The victims/patients have aged and little is currently known how the crisis affected them and their community. Additionally, little is understood about patients affected by serious environmental pollution in socio-economic poverty. This study aimed to describe narratives of these patients from public broadcasting company’s documentaries, as well as to overview media coverage on TV. Descriptive analysis of TV documentaries showed patients’ various concerns and sorrow through their narratives in consecutive years. Archiving these TV documentaries that cover environmental health crises may provide an educational opportunity that does not fade with time. People worldwide can learn from the narratives of patients, even in local environmental health crises, via TV documentaries.

Some prime-time TV dramas containing health topics have large audiences both in the countries in which they are broadcast as well as on an international level via Internet television network. We conducted a literature review to map the current research articles on prime-time TV dramas with health themes produced in so-called developed countries from 1986 to 2014. The review discovered 59 articles, of which 29 (49.2%) examined the portrayal of patients, doctors, and illness; two (3.4%) examined audience characteristics and motives for watching medical dramas; 17 (28.8%) used cross-sectional methods to examine viewers’ knowledge, attitudes, or behaviors related to health concerns; and 11 (18.6%) used either pre- and post-exposure or post-exposure and follow-up tests to assess changes in viewers’ knowledge, attitudes or behaviors related to health concerns. Theories employed to understand changes in viewers’ knowledge and behaviors included cultivation theory, narrative transportation theory, and social cognitive theory. We noted that even viewers who are disinterested in health issues can be exposed to such content with minimal resistance; dramas and movies can be continuously and affordably distributed as streaming content; and large financial investments are being made in the entertainment industry around the world. As a means of health information exposure, then, narrative forms of entertainment content (e.g. dramas and films) should continue to be investigated, particularly their positive and negative effects on audiences.

BACKGROUND: In people with chronic illnesses, self-management education can reduce anxiety and depression. Those benefits, however, decay over time. Efforts have been made to prevent or minimize that "decay of impact", but they have not been based on information about the decay's characteristics, and they have failed. Here we show how the decay's basic characteristics (prevalence, timing, and magnitude) can be quantified. Regarding anxiety and depression, we also report the prevalence, timing, and magnitude of the decay. METHODS: Adults with various chronic conditions participated in a self-management educational program (n = 369). Data were collected with the Hospital Anxiety and Depression Scale four times over one year. Using within-person effect sizes, we defined decay of impact as a decline of ≥0.5 standard deviations after improvement by at least the same amount. We also interpret the results using previously-set criteria for non-cases, possible cases, and probable cases. RESULTS: Prevalence: On anxiety, decay occurred in 19% of the participants (70/369), and on depression it occurred in 24% (90/369). Timing: In about one third of those with decay, it began 3 months after the baseline measurement (6 weeks after the educational program ended). Magnitude: The median magnitudes of decay on anxiety and on depression were both 4 points, which was about 1 standard deviation. Early in the follow-up year, many participants with decay moved into less severe clinical categories (e.g., becoming non-cases). Later, many of them moved into more severe categories (e.g., becoming probable cases). CONCLUSIONS: Decay of impact can be identified and quantified from within-person effect sizes. This decay occurs in about one fifth or more of this program's participants. It can start soon after the program ends, and it is large enough to be clinically important. These findings can be used to plan interventions aimed at preventing or minimizing the decay of impact.

The role of interpreters is significant, and the accuracy of interpretation is the most critical component of safe and effective communication between clinicians and patients in medical settings characterised by language and cultural barriers. Japan has an increasing number of foreign patients, and we report on the results of a pilot study of errors made by 20 Japanese–English interpreters during a simulated medical scenario. Communication was recorded and transcribed for error analysis. Interpretation errors were categorised using five error types: omission, false fluency, substitution, addition, and editorialization, and three kinds of communication content were investigated. Participants with less interpreting experience tended to make more errors. Omission-type errors occurred most frequently. More errors tended to occur in the utterances related to socio-emotional contents. Utterances which express assurance or confirmation were especially likely to be characterized by omission-type errors. Participants’ interpreting experience appeared to be a contributing factor on making errors. The result suggested implications for an integrated training programme to reduce interpretation errors and future research.