Yoshihiko Yamazaki

Illness experience of adults with cervical spinal cord injury in Japan: a qualitative investigation

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

Mental health and positive change among Japanese mothers of children with intellectual disabilities: Roles of sense of coherence and social capital

We investigated predictors of mental health and positive change among mothers of children with intellectual disabilities in Japan based on the concept of the Double ABCX model. We used variables of having a child with autism spectrum disorder (ASD) and dissatisfaction with systems as stressors, availability of social support and social capital (SC) as existing resources, sense of coherence (SOC) as appraisal of the stressor, and mental health and positive change as adaptation. A self-administered questionnaire was distributed to 10 intellectual disability-oriented special needs schools in Tokyo, and obtained 613 responses from mothers of children under age 20 attending these schools. The results showed that our Double ABCX model explained 46.0% of the variance in mothers mental health and 38.9% of the variance in positive change. The most powerful predictor of this model was SOC, and SC may be directly and indirectly related to maternal mental health and positive change through mothers SOC. Increasing opportunity for interaction between neighbors and family of children with disabilities may be one effective way to enhance SOC through SC. Since maternal SOC, SC, mental health, and positive change were significantly correlated with each other, synergy among these elements could be expected.

Physical Punishment, Mental Health and Sense of Coherence Among Parents of Children with Intellectual Disability in Japan

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

Having another child without intellectual disabilities: Comparing mothers of a single child with disability and mothers of multiple children with and without disability:

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

Reliability and validity of a 12-item medication adherence scale for patients with chronic disease in Japan

BackgroundTo 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.MethodsWe 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.ResultsThe 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/dfu2009=u20092.6, CFIu2009=u20090.94, and RMSEAu2009=u20090.069. 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 40–49xa0years versus age 20–29xa0years. These relationships were the same as in previous studies.ConclusionsWe 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.

Public perceptions toward mental illness in Japan

AIMnThe purpose was to characterize public perceptions in Japan of mental illness and how they related to stigma-related attitudes for the same.nnnMETHODSnData were obtained using a vignette survey conducted as a part of the Stigma in Global Context - Mental Health Study and contained a nationally representative sample (nu202f=u202f994). The survey was conducted using a multi-mode approach (face-to-face interviews, the drop-off-and-pick-up, postal collection) from September to December 2006, with a multi-stage probability sample of Japanese residents aged 18-64 years. Respondents were randomly assigned one of four vignette conditions that described psychiatric disorders meeting the diagnostic criteria for schizophrenia and major depressive disorder (one vignette for each gender exhibiting each diagnosis). We compared respondents stigma-related attitudes and perceptions toward mental illness between vignettes.nnnRESULTSnOver 80% of Japanese participants believed that depressive disorder or schizophrenia could be cured via treatment. However, Japanese people still had relatively strong vigilance and denial of competency toward schizophrenia.nnnCONCLUSIONSnParticipants expressed the belief that mental illnesses are curable, but stigma toward people with schizophrenia was still relatively strong.

Perspectives on Salutogenesis of Scholars Writing in Japanese

Research on salutogenesis and sense of coherence in Japan started between 1998 and 2001 with translations of Antonovsky’s work and the creation of a Japanese language version of the 29-item seven-point scale and a 13-item short version. These were later developed into a 13-item, five-point scale, the original three-item scale, and a scale for children. Since 2003, as Yamazaki and his colleagues have continued to promote sense of coherence research in Japan, original papers that included sense of coherence and the related terms as keywords have dramatically increased. Approximately 300 papers have been published in the last 11 years. Sixty percent of these studies used sense of coherence as an independent variable, and 20 % as a dependent variable. Seventy-five percent were cross-sectional studies, 10 % follow-up studies, and 8 % qualitative studies. As many as 103 studies were awarded the Japanese government Grant-in-Aid. Fifteen doctoral dissertations in Japan also had these keywords. The research participants were drawn from wide ranging population categories such as the general population, patients, workers, students, the elderly, children, and families. The research themes can be divided into “factors related to the formation and improvement of sense of coherence,” “associations between sense of coherence and health and health behavior,” “stress coping function of sense of coherence,” and “support and improvement strategies for sense of coherence.” For the future, we hope to see research topics such as “investigation of sense of coherence factors and support and improvement strategies,” “investigation of sense of coherence functions, effects, and mechanisms,” “deepening the theoretical foundation of sense of coherence and the salutogenic model,” and “applications of salutogenesis and sense of coherence to new areas.”

Disclosure of congenital cleft lip and palate to Japanese patients: reported patient experiences and relationship to self-esteem.

BackgroundThe present study investigated when and how Japanese people with cleft lip and palate (CL/P) learn that their condition is congenital; the perceived effects of withholding the CL/P diagnosis on patients; and whether the resulting social experience and self-esteem are related. A questionnaire survey was conducted in 71 adults with CL/P recruited through a hospital, a patients’ association, and by snowball sampling.ResultsThe participants became aware of their physical difference in childhood, but many reported difficulty in understanding their condition. Participants reported that their families avoided the topic of diagnosis. Participants who understood their condition during childhood rather than in adulthood were significantly more likely to consider this scenario as positive (pu2009<u20090.001). Although stigmatising experiences were extremely painful, most patients hid their suffering, making it more difficult to obtain social support. Participants with high self-esteem were more likely to feel that they received adequate support.ConclusionsIt is important to explain the congenital nature of CL/P sufficiently and early. In addition, openness by the family about the diagnosis, rather than avoidance, may improve patients’ self-esteem. Sufficient support from family, health care providers, and significant others is needed for patients to develop adequate self-esteem.