母親のヘルスリテラシーを測定している尺度に関する文献検討

目的：近年，健康や医療に関する情報を入手，理解，評価，活用して健康に結びつく意思決定ができる力であるヘルスリテラシーが健康を決める力として注目されている．本研究では，母親の育児に関するヘルスリテラシーを把握できる尺度の必要性を検討するため，国内外で母親のヘルスリテラシーを測定している尺度について，その特徴と関連する要因について明らかにすることにした． 方法：2018年10月にPubMed，医学中央雑誌の２データベースを使用し，MeSH Termsを用いて1990年から2018年の母親のヘルスリテラシーに焦点をあてた文献を検索した． 結果：16件の英語文献が抽出された．米国における研究が14件で最も多く，日本人を対象とした研究はなかった．多く用いられていた測定尺度は，母親を対象に開発された尺度ではなく，広く成人を対象に用いられている尺度であり，基本的な識字能力をみる機能的リテラシーを測定する尺度であった．母親のヘルスリテラシーの関連要因として，母親の年齢や教育，社会経済的状態など先行研究と同様の結果と子どもへの薬の投薬方法，子どもの睡眠状況や疾患の症状，重症度など子どもの健康に関連する特徴的な結果が得られた． 考察：本研究の結果，母親のヘルスリテラシーを高めることの必要性が示唆された．しかし，母親のヘルスリテラシーを測定していた尺度は，元々それを測定するために開発されたものではなく，どのような対象でも汎用性がある尺度であった．そこで，一定の社会保障が確保され，識字率が高い日本の母親を対象とした信頼性と妥当性のあるヘルスリテラシー測定尺度の開発が必要である．また，今後は健康や医療に関する情報はもちろん，子どもとのつながりを重視した育児に焦点をあてた母親の育児に関するヘルスリテラシーを適切に把握できる尺度の開発が必要であると考える．Objective: In recent years, health literacy – which empowers people to make better health decisions through the reception, understanding, evaluation, and utilization of information about health and medicine – is garnering attention as a driver of health. This study aimed to investigate the need for measures that assess health literacy regarding child rearing in mothers and to clarify the characteristics of current health literacy measures in Japan and abroad, as well as factors related to health literacy. Method: In October 2018, we conducted a search for studies focused on health literacy in mothers published between 1990 to 2018 using Medical Subject Heading (MeSH) terms in two databases, PubMed and Igaku Chuo Zasshi. Results: The search returned 16 studies in English. Most (n=14) were from the United States and none were conducted on Japanese subjects. The measures used in these studies were not specifically developed for mothers, but functional literacy measures widely used on adults to assess basic literacy. With regards to factors related to health literacy in mothers, the studies supported results from previous work (e.g. mother’s age, education, socioeconomical status) as well as identified characteristic factors related to child health (e.g. children’s sleep conditions, symptoms and severity of disease). Discussion: The results suggested the necessity to improve health literacy in mothers. However, the measures used to examine health literacy in mothers were not originally designed for that purpose; instead, they were versatile measures applicable for a wide range of subjects. Therefore, it is necessary to develop a health literacy measurement scale with reliability and adequacy for Japanese mothers with a certain level of social security and high literacy rate. In addition to distributing information on health and medicine, developing measures for grasping health literacy appropriately regarding child rearing in mothers – particularly with emphasis on the importance of the connection with the child – is a crucial area of future work

Relationship between the Contentment of Mothers of Infants with Parenting Advice and Their Recognition in Judging Credibility

Background: This study sought to clarify the contentment of mothers of infants with parenting advice, judgment regarding credibility of parenting advice, and the relationship between such contentment and judgment. Methods: We conducted an anonymous, self-reported questionnaire-based survey from April to June 2016, targeting 1,118 mothers of infants in Prefecture A. The questions covered basic attributes, contentment with parenting advice, and judging the credibility of such advice. Descriptive statistics were compiled for each factor. A t-test was performed to examine the relationship between contentment with parenting advice and judging the credibility of parenting advice. This study was conducted with the approval of the Ethics Committee of Tokushima University Hospital. Results: The questionnaires were returned by 272 subjects (collection rate of 24.3%), with 265 determined as valid (valid response rate of 23.7%). The mean score for contentment concerning parenting advice was 6.17 (standard deviation: ±1.69). More than 80% of the subjects indicated being able to select credible parenting advice, and more than 70% had sought professional consultation about childrearing. However, among subjects who had not sought professional consultation, some had wanted to seek professional consultation but had not been able to do so. Relating contentment to judging the credibility of parenting advice, the mean contentment scores of the subjects who felt able to select credible parenting advice were significantly higher than the scores of those who did not (p < 0.01). Conclusion: Although study participants’ contentment relating to parenting advice seemed higher than that of teenage mothers, their levels of contentment appeared insufficient. Additionally, some subjects wanted to seek professional consultation about childrearing but could not. Furthermore, mothers who reported being able to select credible parenting advice were found to obtain and apply sufficient parenting advice, compared to those who did not feel the same confidence

Interactive Supports Between Children and the Elderly At-home Using Integrated Care Facilities

本研究の目的は，地域のケア資源となり得る統合ケア施設を利用する在宅高齢者の子どもとのサポート授受の実態，およびサポート授受と高齢者の生きがいとの関連を明らかにすることである．西日本の統合ケアを実施している７施設に依頼をし，協力の得られた５施設のデイサービスを利用する在宅高齢者のうち，認知症がないという条件で施設管理者に選出いただいた７５人を対象とした．一人当たり１５分程度の個別面接質問紙調査を２００９年４月～９月に行った．調査内容は，対象者の特性，サポート授受，生きがいである．サポート授受については先行研究を参考に独自の質問票を作成し，生きがいについては，生きがいの源泉・対象と生きがい感（PGC モラールスケール）を調査した．分析では，記述統計，サポート授受の２群の差はWelch’s t-test，サポート授受と生きがいについてはロジスティック回帰分析，Pearsonの相関係数を行い，自由回答の内容については意味内容の類似性に従いカテゴリへと抽象化した．なお，所属機関の研究倫理審査委員会の承認を得た．認知症の疑いがないHDS-R で２１点以上の７０人を分析対象者とした．サポート授受は主に情緒的なサポート授受であった．生きがいとの関連については，生きがいの源泉・対象は受領サポートの「感動させてくれる」の項目と有意な関連がみられ，生きがい感は提供サポートの「元気がないときに温かく励ます」の項目と有意な正の相関がみられた．以上のことから，統合ケア施設を利用する在宅高齢者の子どもとのサポート授受は，情緒的なサポート授受が主たるものであった．また，提供サポートだけでなく，受領サポートが高齢者の生きがいに関連していることが示唆された．しかし，子どもに対して必ずしも肯定的な感情をもっているとはいえないため，統合ケアを行うにあたり，高齢者や子どもの特徴を理解し，交流を調整することが必要であると考えられる．The purposes of this study were to clarify interactive supports between the elderly and children as a form of social resource for care, and to clarify the relationship between the interactive supports and motivations in life for the elderly. The subjects of this study wer ７５ elderly individuals who used one of five integrated care facilities in western Japan. Fifteen-minute individual interviews with a questionnaire were administrated in April through September ２００９．The contents of the questionnaire were basic attributes, motivations in life and interactive supports. Regarding motivations in life, the Philadelphia Geriatric Center（PGC）Morale Scale was used. Regarding interactive supports, an original scale prepared from the preceding studies was used. For the analysis of this study, descriptive statistics was performed, and coefficient of correlation and multiple logistic regression analysis were used. The responses to open questions were categorized according to similarity. This study was approved by the ethical committee of our institute. As a result，７０ subjects were valid for this study. Regarding the relationship between their motivations in life and the supports, there was a positive relationship between the sources and subject matters of the motivations and the items regarding the supports received. Further, between the motivations and the items regarding the supports provided, there was a positive relationship. Based on these findings, interactive supports between the elderly in integrated care facilities and children were emotional ones. In integrated care, it is important to understand the association between the characteristics of the elderly and children with those of the community, and to adjust interactions between them

Current status of disaster awareness among mothers with infants : comparison before and after attending a disaster prevention seminar

目的：本研究の目的は，防災セミナーを受講した乳幼児をもつ母親の防災意識と，受講前後での防災意識の変化を明らかにすることである． 方法：A 県内で乳幼児をもつ母親を対象に複合災害に関するオンラインセミナーを開催し，セミナー前後でWeb アンケート調査を実施した．調査内容は，基本属性，複合災害の知識と情報源，防災意識，災害への備えについて等である．分析方法は，各調査項目の記述統計，セミナー受講前後の防災意識については対応のあるt 検定を用いた． 結果：分析対象者は27名である．複合災害について，あまり知らない，知らないと回答した者は９割を超え，知っている者は１割にも満たなかった．その情報源は，テレビ・ラジオが７割で最も多かった．防災意識については，セミナー受講後に尺度得点が有意に上昇（p ＜.001）し，因子毎の分析では，第１因子「被災状況に対する想像力」，第３因子「他者指向性」で防災意識が上昇し有意差を認めた（第１因子，第３因子：p ＜.001）．災害への備えについては，セミナー受講後に全ての項目で新たに準備したいと思う準備物品が増加し，おもちゃや離乳食等，子どものための物も増加した． 考察：本調査では，乳幼児をもつ母親の複合災害に関する知識不足や，子どものための災害への備えが十分ではない現状が明らかとなった．セミナー受講後に，防災意識や災害時の備えに対する認識が向上したことから，本セミナーが防災意識の向上に有効である可能性が示唆された．今後，母子とその家族を対象にした複合災害に関する普及啓発活動や，防災意識を防災行動へと繋げるための効果的なアプローチ方法の検証等，地域における継続した取り組みの必要性が示唆された．Objective : To determine the levels of disaster awareness among mothers of infants and toddlers, and the changes in such awareness after their participation in a disaster seminar. Methods : We conducted an online seminar on disaster prevention for mothers of infants and toddlers in prefecture A, and administered a web-based questionnaire survey before and after the seminar. The questions sought to obtain information on the participants’ basic attributes as well as their knowledge and sources of information on complex disasters, disaster awareness, and disaster preparedness. We used descriptive statistics and a corresponding t-test to analyze changes in disaster awareness and demonstrate changes in perceptions of preparedness. Results : Among the 27 participants, over 90% had little or no knowledge about complex disasters. Less than 10% had some knowledge. The most common sources of information about complex disasters were television and radio, comprising a total of 70%. Disaster preparedness scores increased significantly （p <.001） after the seminar. Furthermore, factor analysis demonstrated a significant increase and differences in Factors 1, and 3, that is, “imagination of disaster situation,” and “other-orientedness” （Factors 1 and 3 : p <.001）. The number of items that the respondents wanted to prepare for themselves and their children（ e.g., toys and baby food） increased in all categories after the seminar. Discussion : This study revealed that the participants lacked knowledge regarding complex disasters and were inadequately prepared to face such disasters with their children. As the participants’ disaster awareness and preparedness increased after the seminar, the seminar could be considered effective. Our findings suggest the need for continued disaster-related efforts in the community, including the implementation of awareness-raising activities for mothers, children, and their families regarding complex disasters, as well as the verification of approaches that effectively lead from disaster prevention awareness to concrete action

Analysis of the learning-targets of the nursing university students during practicum of community health nursing

【目的】本研究の目的は，地域看護学実習において，看護系大学で学ぶ４年次学生がどのような学習目標を持って臨んでいるのかを明らかにすることである． 【方法】地域看護学実習開始１ヵ月前に，実習要項に沿って実習目標および方法について説明を受けた後，学生９２人が考え，記載した学習目標（保健所実習で学びたいこと，市町村実習で学びたいこと）の内容を分類した． 【倫理的配慮】学生には，研究目的を説明したうえで，研究への協力の有無は成績評価とは無関係であること，研究資料としての提供は自由意志であること，協力の諾否により不利益はもたらさないことを説明した．学生の学習目標の内容分類にあたっては，氏名や実習先を伏せ個人を特定できないようにした． 【結果】保健所実習における学習目標は，「保健師の業務や役割の学習」，「保健所の連携機能に注目しての学習」，「健康危機管理についての学習」，「地域の特性を考慮した学習」，「自己の関心に基づく焦点化した課題学習」に分類された．市町村実習における学習目標は，「保健師の業務や役割の学習」，「地域の特性を考慮した学習」，「自己の関心に基づく焦点化した課題学習」に分類された． 【考察】内容は抽象的なものから具体的なレベルのものまであった．市町村の学習目標からは，保健所の場合より地域に密着した保健師活動について学ぼうとする姿勢が窺えた．近年，各市町村が工夫を凝らしたホームページにより詳細な地域情報の提供を行っており，実習地域の事前学習で地域特性をイメージしやすく関心も高まったためと思われる．Purpose : This research is to clarify what learning-targets fourth year nursing university students have during a practicum of community health nursing. Methods : One month prior to the start of the practicum, ９２ students were explained about the practical objectives and methods in line with essential practicum items. The contents of the learning-targets（things they hoped to learn in practical training at healthcare centers and in municipalities）thought up and noted by the students were classified. Ethical Consideration : The students were explained about the research purpose and then the following : the fact that they would not be subject to grade evaluation ; that their provision as a research material was voluntary ; and that whether or not they would cooperate in the research was not to cause any disadvantage to them. In the classification of the learning-targets of the students, their anonymity was secured by concealing their private information such as name and the place of practical training. Results : In the practical training at healthcare centers, the learning-targets were classified as : “Learning of the duty and role of a public health nurse”, “Learning of the collaborative function of healthcare centers as a key focus”, “Learning of health risk management”, “Learning with consideration on community characteristics”, and “Task-oriented learning based on the focus of one’s own interest”. In the practical training in municipalities, the learning-targets were classified as : “Learning of the duty and role of a public health nurse”, “Learning with consideration on community characteristics”, and “Task-oriented learning based on the focus of one’s own interest”. Discussion : The contents of the learning-targets ranged from abstract ones to specific ones. The learning-targets in the practical training in municipalities indicated the active attitude of the students to learn the work of public health nurses which was linked to the community more than healthcare centers were. In recent years, each municipality provides its own regional information through its ingenious homepage. In the prior study on the place for practical training, this is believed to have helped the students image the community characteristics and consequently take a better interest in the place

山間地域に住む高齢者の保健行動

【目的】本研究の目的は山間地域で主体的に運営する産業に従事している高齢者の保健行動を明らかにすることである． 【方法】対象者：産業に従事している高齢者（以下A 群）８４人と従事していない高齢者（以下B群）８１人である．データ収集方法：集合法で自記式アンケート調査を行った．期間：２００９年５月から９月に行った．調査項目：基本情報・生きがい・生活習慣・生活活動能力・疲労蓄積度（厚生労働省）で構成し，５２項目を設定し選択式回答とした．分析：回答者のうち，６５歳未満を除いた１４４人（８７．３％）について分析を行った．A群とB群の保健行動について，生きがい，生活習慣，生活活動能力に関する質問項目を記述集計およびクロス集計によって統計学的に分析した．倫理的配慮：所属機関の臨床研究倫理審査委員会の審査を受けた． 【結果】A 群はB群に比べて高齢者の集まりに入会している人の割合が有意に少なく（p＜０．０１），活動している人の割合も有意に（p＜０．０１）少なかった．A群の方がB群に比べて現病歴のある人の割合が少ない傾向（p＝０．０５４）が認められた．生活に対する意識について，「不満」「非常に不満」と回答したのは，A群に多く，両群間に有意な差（p＜０．０１）が認められた．疲労蓄積度の自覚症状の平均値は，A群では８．８±５．７点，B群は６．１±４．８点であった．A群では，疲労の自覚症状が３９点中１１～２０点であったのは１７人（２９．７％），それ以上は２人（３．４％）であったのに比べ，B群では前者が１６人（２２．２％），後者はおらず有意な差（p＜０．０５）があった． 【考察】A群は疲労蓄積度が高く，高齢者の集まりに参加している人が少なかったことから，A群は余暇活動をする時間がないほどに仕事に力を注いでいると考えられた．それにもかかわらずA群は現病歴のある人の割合が少なく，主体的な産業に従事できる程の健康状態を維持していることが示唆された．【Aim】This study aims to clarify the health behavior of the elderly who were managing profit-earning works in mountainous areas. 【Methods】The elderly aged more than ６５ year-old in the areas in T Prefecture were targeted. The elderly who were managing profit-earning works named Group A, and the elderly who were not named Group B. A questionnaire was conducted to the participants at local regular meetings from May to September, ２００９. The questionnaire consisted in five sections, such as, living habits, abilities of daily activities and the degree of fatigue accumulation１４）. The data was analyzed a comparison between two groups. This study was reviewed by the clinical ethic board of the institution to which the authors belong. 【Results】The total of １４４ participants were analyzed. The number of Group A was ６３, and Group B was ８１. There was a significant difference in average age between two groups. Regarding abilities daily activities, the admission of a public meeting for elderly of Group A in the areas was significantly lower than that of Group B. Group A was significantly lower the rate of present illness than that of Group B. Regarding fatigue accumulation, the difference between Group A and Group B were significant（p＝０．０３１）. 【Discussion】Group A seemed to favor their own profit-earning activities more than the admission of the activities for the elderly by public. Group A, however, felt more being fatigue than that of Group B. In addition, Group A seemed to have less present illness than Group B. Group A seemed to maintain their health and their work and life balance. Therefore, we considered to clarify that health behavior that consisted in the five sections was well maintained by the elderly who manage profit-earning activities

Health behavior of elderly people engaged in agriculture in conjunction with information communication technology

The aim of this study is to clarify the health behavior of elderly people engaged in agriculture and information communication technology (ICT). The participants were 61 people engaged in agriculture in conjunction with ICT systems (group A), and 49 people not engaged in this (group B) from among the people aged 65 years or over in village C, both living located in a mountain areas. Data were collected from August 2009 to June 2011 in two stages : interviews to members of group A through home visits, and a group survey of groups A and B through questionnaires. The results of the study were as follows : 1) members of group A lived with feelings of attachment to the land to which they were accustomed and showed gratitude to their ancestors ; 2) in group A, the desire of participants to continue their life was sufficient motivation to look after their own health and maintain independence ; and 3) they provided a new challenge and a sense of achievement. The results suggest that the health behavior in group A was behavior adopted voluntarily in order to maintain an independent lifestyle supported by working, and it is likely to be linked to the preservation of health

Visiting Nurses’ Awareness of the Current State of Clinical Practicum and Guidance

本研究は，訪問看護師への質問紙調査から，看護学生に対する訪問看護師の実習指導の現状と実習指導についての意識を知ることを目的に実施した．対象は，A県で在宅看護実習を受け入れている訪問看護ステーションの訪問看護師１９８名であった．質問は，実習指導の現状（２０項目）と実習指導の意識（１０項目）に，「当てはまる（５点）」から「全く当てはまらない（１点）」の５段階で回答を求めた．その結果，実習指導の現状では「学生の利用者や家族への理解が深まるように情報を提供している」「学生が連携について理解が深まるように助言している」「学生に指導するときは言葉や伝え方に配慮している」の３項目が４．４０と高かった．実習指導についての意識では，「指導することを通して自分の成長につながる」「指導することで学びなおす機会となる」の２項目が４．１７と高かった．また，実習指導の際に心がけていることや信念への自由記載から，【対象全体を捉えやすくする】【思いや基本を伝える】【対象の尊重と支援の方法を伝える】【共に学ぶ存在として学生をとらえる】の４カテゴリが抽出された．以上のことから，訪問看護師は学生に対して，マニュアルに頼らず，利用者や連携についての情報提供や助言をしており，個々に合わせた指導をしている現状がわかった．また，訪問看護師は学生が緊張しないように，言葉や伝え方に配慮をして学生に関わっていることが明らかになった．訪問看護師経験の長い者の方が，実習指導を，自分自身の学び直す機会や自分の成長につながる経験であると捉えており，実習指導についての意義を見いだしていると思われた．また，雇用形態によって，実習要項の確認や記録への助言，反省会への参加などに差があり，訪問看護師間における情報伝達や指導方法についての工夫が必要である．This research aimed to study clinical practicum provided by visiting nurses to nursing students and awareness of the practicum. The participants were １９８ visiting nurses at visiting nurses’ stations in Prefecture A. They responded to questions on the actual state of clinical practicum （２０items） and on their awareness of practicum （１０items） by choosing one of the items of a ５-point Likert scale, where ５ was “Applicable” and１ “Not Applicable at All”. Regarding the actual state of practicum, three items received a high score of ４．４０: “Providing information to enhance the students’ understanding of service-users and users’ families” ; “Helping the students improve their understanding of cooperation” : and “Being considerate of the ways of communication when giving guidance”. Regarding their awareness of practicum, two items received a high score of４．１７ : “Giving guidance leads to my own growth” and “Giving guidance is an opportunity to relearn”. Further, four categories were extracted from their free descriptions : Easier to grasp the entirety of care targets ; Communicating thoughts and basics ; Teaching the way to respect and support care targets ; and Seeing the students as co-learners. The findings indicate that the visiting nurses tailored their guidance according to the students’ individuality, and did not rely on manuals in providing the students with advice and information about clients and cooperation. Furthermore, they were considerate of their words and ways of communication to avoid putting the students under pressure. In addition to grasping the the real significance of a practicum, those experienced visiting nurses tended to consider practicum as an opportunity to relearn, and improve themselves. There were differences between visiting nurses with regard to their employment statuses, their advice on checking and reporting of practicum requirements, and to their participation in evaluation meetings. Finally, the results of the present study underscore the need to improve the capacity of visiting nurses to communicate information and give guidance

Health literacy of mothers with infants as perceived by public health nurses

目的：保健師が乳幼児をもつ母親の育児に関するヘルスリテラシーの現状をどのように捉えているかを明らかにすることを目的とした． 方法：A 県の地域特性が異なる２市３町で働く母子保健業務経験年数３年以上の保健師５人を　研究参加者とした．2018年３月～４月に半構成的面接調査を実施した．調査内容は，最近の母親の育児に関するヘルスリテラシーの現状をどのように捉えているか，それは子どもの健康にどのように結びついているか，育児情報を提供するにあたって上記のことを考慮して提供しているか等であり，質的帰納的に分析した．倫理的配慮として，研究参加者には，研究目的等を口頭および文書で説明し，同意書に署名を得た．本研究は，所属大学の倫理審査委員会の承認を得て実施した． 結果：保健師が捉える乳幼児をもつ母親の育児に関するヘルスリテラシーの現状として，【身近な育児情報源へのアクセス】，【コミュニケーション不足による育児情報の不十分な理解】，【自己の価値観による育児情報の選択】，【子どもの状況よりもマニュアル優先】，【信頼できる育児情報の見極め】，【溢れる育児情報に翻弄される子育て】の６つのカテゴリ，16のサブカテゴリ，36のコードが抽出された． 考察：保健師は，情報が溢れかえる中で育児をしている母親に対して，保健師等の専門職をはじめ信頼できる情報源から上手く情報を活用できるよう教育の必要性を感じていた．また，今後ますます情報化が進展し，新型コロナウイルスのように新たな感染症が出現してオンライン支援が主となってくる中，母親の育児に関するヘルスリテラシーを高める支援の重要性が示唆された．OBJECTIVE : To clarify how public health nurses perceive the health literacy of mothers with infants regarding childcare. METHODS : The study participants were five public health nurses with >3 years of experience in maternal and child health care working in two cities and three towns with different regional characteristics in prefecture A. A semi-constructive interview-based survey was conducted from March to April 2018, which included a qualitative inductive analysis of how public health nurses perceive the current state of health literacy regarding childcare. The study purpose was explained verbally and in writing, and the participants signed a consent form. This study was approved by the ethical review committee of the affiliated university. RESULTS : The public health nurses recognized several key factors in health literacy : （1） mothers having access to familiar sources of child-rearing information ; （2） inadequate understanding of child-rearing information due to poor communication ;（3） mothers selecting child-rearing information based on their own values ;（4） child-rearing manuals taking precedence over the child’s situation ;（5） identifying reliable childcare information ; and （6） mothers performing child-rearing at the mercy of excess information. DISCUSSION : Public health nurses felt the need to educate mothers so that they can make good use of reliable information, including from public health nurses and other professionals. As information technology continues to advance, new infectious diseases （e.g., coronavirus disease） emerge, and online support becomes the mainstay of support. The importance of supporting mothers to increase their health literacy regarding childcare was suggested