Hirono Ishikawa

Patient health literacy and participation in the health‐care process

Objectives  Health information is an important resource for patients to understand and engage in the management of their health conditions. We discuss the role of health literacy (HL) in improving patient participation and propose future research in this field.

Developing a measure of communicative and critical health literacy: a pilot study of Japanese office workers

With the increase in media reports and rapid diffusion of the Internet, the skills in finding and utilizing health information (health literacy; HL) are becoming important in maintaining and promoting health. This study aimed to examine the psychometric properties of a brief measure to assess major components of communicative and critical HL among Japanese office workers, in order to consider its applicability to health promotion at workplace. The participants were 190 male office workers at a Japanese company. A self-administered questionnaire was distributed at the annual health checkup, in which HL, health-related behaviors and coping with job stress were asked. Also, the number of somatic symptoms reported by the worker was counted out of the eight symptoms in the health checkup questionnaire. The higher HL group was more likely to have regular eating patterns and exercise weekly, and tended to be a never smoker. In coping with job stress, those with higher HL were more likely to actively solve the problems or seek support from others, whereas those with lower HL were more likely to be resigned to the situation. Further, lower HL group reported significantly greater number of somatic symptoms than higher HL group. These findings were generally as hypothesized, supporting the validity of the HL scale among office workers. Further research on HL is needed to explore the extent and impact of HL on health outcomes.

Physician-patient communication and patient satisfaction in Japanese cancer consultations

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.

The impact of subjective and objective social status on psychological distress among men and women in Japan

From around 1990s, social disparity issues and their effects on mental health have been gaining increasing attention in Japanese society. Findings from previous studies on socioeconomic status (SES) and mental health in Japan are inconsistent. Subjective Social Status (SSS) has been proposed and tested as a stronger predictor of mental health than measures such as education, income and occupation in the UK and US, but this has not been tested enough in countries with a different social and cultural background such as Japan. In the present study, a cross-sectional questionnaire survey was conducted in 2006 among a nationally representative community-based random sample of residents in Japan aged 20-74 years. A total of 1237 participants completed the questionnaire, with the overall response rate of 61.9%. After excluding 42 respondents, data from 1195 respondents (574 men and 621 women) were analyzed. SSS, household income, and education level of respondents were measured using single-item questions. Those with a K6 score of 5 or greater were defined as having psychological distress. A multiple logistic regression model was used to examine the effects of SSS, household income, and education on psychological distress. Among men, the prevalence of psychological distress, after adjusting for age and marital status, differed significantly across groups classified based on SSS, household income, and education. Among women, only SSS was significantly associated with psychological distress after adjusting for age and marital status. However, when all three variables were simultaneously entered into the model, SSS and household income were significantly associated with psychological distress, with the low SSS group having a higher odds ratio of psychological distress. In summary, SSS seems to be a stronger predictor of psychological distress among both men and women in the Japanese community than traditional measures of SES.

Patient health literacy and patient-physician information exchange during a visit.

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 patients 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 patients perceptions of the information exchange. Further, patient communicative HL had a modifying effect on the relationship between physicians information giving and patients perception of it, suggesting that physicians communication may be perceived differently depending on the patients HL. CONCLUSION The exploration of patient HL may provide a better understanding of potential barriers to patient-physician communication and patients self-management of disease.

Health literacy and health communication

Health communication consists of interpersonal or mass communication activities focused on improving the health of individuals and populations. Skills in understanding and applying information about health issues are critical to this process and may have a substantial impact on health behaviors and health outcomes. These skills have recently been conceptualized in terms of health literacy (HL). This article introduces current concepts and measurements of HL, and discusses the role of HL in health communication, as well as future research directions in this domain. Studies of HL have increased dramatically during the past few years, but a gap between the conceptual definition of HL and its application remains. None of the existing instruments appears to completely measure the concept of HL. In particular, studies on communication/interaction and HL remain limited. Furthermore, HL should be considered not only in terms of the characteristics of individuals, but also in terms of the interactional processes between individuals and their health and social environments. Improved HL may enhance the ability and motivation of individuals to find solutions to both personal and public health problems, and these skills could be used to address various health problems throughout life. The process underpinning HL involves empowerment, one of the major goals of health communication.

The interaction between physician and patient communication behaviors in Japanese cancer consultations and the influence of personal and consultation characteristics.

The communications of physician and patient vary with the characteristics of patient and consultation, as well as the communications of the counterpart. The purpose of this study is to explore the interaction between physician and patient communications in Japanese cancer consultation in view of the influence of patient and consultation characteristics. One hundred and forty cancer outpatients and 12 physicians were included in this study. The Roter Interaction Analysis System (RIAS) was used to analyze the physician-patient interaction. Patient information giving was positively related to physician facilitation, while patient question asking and emotional expression were associated with the warm and empathetic attitude of the physician. On the other hand, the encouraging statements of the physician were greater in shorter consultations, which implies physicians might have interrupted patients with encouragement before thoroughly listening to the patients concern. Further investigation is needed to confirm the causal relationships of these interactions.

The Association of the Reporting of Somatic Symptoms with Job Stress and Active Coping among Japanese White-collar Workers

The Association of the Reporting of Somatic Symptoms with Job Stress and Active Coping among Japanese White‐collar Workers: Kyoko Nomura, et al. Department of Hygiene and Public Health, Teikyo University School of Medicine—To assess the associations between job stress and somatic symptoms and to investigate the effect of individual coping on these associations. In July 2006, a cross‐sectional study was conducted during a periodic health check‐up of 185 Japanese male office workers (21–66 yr old) at a Japanese company. Job stress was measured by job demand, control, and strain (=job demand/control) based on the Job Content Questionnaire (JCQ). Major somatic symptoms studied were headache, dizziness, shoulder stiffness, back pain, shortness of breath, abdominal pain, general fatigue, sleep disturbance, and skin itching. Five kinds of coping were measured using the Job Stress Scale: active coping, escape, support seeking, reconciliation, and emotional suppression. Comorbidities of hypertension, diabetes, obesity, depression, and anxiety were also evaluated. The most frequently cited somatic symptom was general fatigue (66%), followed by shoulder stiffness (63%) and sleep disturbance (53%). Of the five kinds of coping, only “active coping” was significantly and negatively associated with the number of somatic symptoms. The generalized linear models showed that the number of somatic symptoms increased as job strain index (p=0.001) and job demand (p=0.001) became higher, and decreased as active coping (p=0.018) increased, after adjusting for age and comorbidities. There was no statistical interaction among active coping, the number of somatic symptoms, and the three JCQ scales. Reporting somatic symptoms may be a simple indicator of job stress, and active coping could be used to alleviate somatization induced by job stress.

Comprehensive health literacy in Japan is lower than in Europe: a validated Japanese-language assessment of health literacy

BackgroundHealth literacy, or the ability to access, understand, appraise and apply health information, is central to individuals’ health and well-being. A comprehensive, concept-based measure of most dimensions of health literacy has been developed for the general population in Europe, which enables comparisons within and between countries. This study seeks to validate this tool for use in Japan, and to use a Japanese translation to compare health literacy levels in Japan and Europe.MethodsA total of 1054 Japanese adults recruited through an Internet research service company, completed a Japanese-language version of the 47-item European Health Literacy Survey Questionnaire (HLS-EU-Q47). The survey was administered via an online questionnaire, and participant demographics were closely matched to those of the most recent Japanese national census. Survey results were compared with those previously reported in an eight-country European study of health literacy.ResultsInternal consistency for the translated questionnaire was valid across multiple metrics. Construct validity was checked using confirmatory factor analyses. The questionnaire correlated well with existing scales measuring health literacy and mental health status. In general, health literacy in the Japanese population was lower than in Europe, with Japanese respondents rating all test items as more difficult than European respondents. The largest difference (51.5 %) was in the number of respondents finding it difficult to know where to get professional help when they are ill.ConclusionsThis study translated a comprehensive health literacy questionnaire into Japanese and confirmed its reliability and validity. Comparative results suggest that Japanese health literacy is lower than that of Europeans. This discrepancy may be partly caused by inefficiency in the Japanese primary health care system. It is also difficult to access reliable and understandable health information in Japan, as there is no comprehensive national online platform. Japanese respondents found it more difficult to judge and apply health information, which suggests that there are difficulties in health decision-making in Japan.Numerous issues may be linked to lower levels health literacy in Japan, and further studies are needed to improve this by developing individual competencies and building supportive environments.

Communicative and critical health literacy, and self-management behaviors in end-stage renal disease patients with diabetes on hemodialysis

OBJECTIVE Health literacy (HL) has been linked to disease self-management and various health outcomes, and can be separated into components of functional, communicative and critical skills. The high comorbidity between diabetes and end-stage renal disease (ESRD) poses concerns for compromised disease self-management. This study aimed to identify the relationships between HL and self-management behaviors in end-stage renal disease patients with diabetes. METHODS Self-report questionnaires measuring HL and self-management with the functional, communicative and critical HL scale and Summary of Diabetes Self-Care Activities, respectively, were implemented with a sample of 63 patients. Socio-demographic and clinical characteristics were obtained from medical records. RESULTS Self-management in diabetes was associated with communicative and critical HL, but not functional HL. Educational attainment was associated only with functional HL. No relationship between HL and glycated hemoglobin (HbA1c) was identified. CONCLUSION Communicative and critical HL skills are associated with self-management in ESRD patients with diabetes. Education levels are not related to self-management. PRACTICE IMPLICATIONS Healthcare professionals and health information aiming to improve self-management in ESRD patients with diabetes should consider their capacities of communicative and critical HL instead of solely assessing functional HL.