Japanese Translation and Cross-Cultural Validation of the Adult Social Care Outcomes Toolkit (Ascot) in Japanese Social Service Users

The aim of this study was to develop and perform cross-cultural validation of a Japanese version of the Adult Social Care Outcomes Toolkit (ASCOT) four-level Self-Completion questionnaire (SCT4) instrument to measure Social-Care Related Quality of Life. It was important to develop a Japanese version of the ASCOT-SCT4 and validate it in the Japanese context, given the interest in measuring outcomes of social care services in Japan

Japanese translation and cross-cultural validation of the Adult Social Care Outcomes Toolkit (ASCOT) in Japanese social service users

Background: The aim of this study was to develop and perform cross-cultural validation of a Japanese version of the Adult Social Care Outcomes Toolkit (ASCOT) four-level Self-Completion questionnaire (SCT4) instrument to measure Social-Care Related Quality of Life. It was important to develop a Japanese version of the ASCOT-SCT4 and validate it in the Japanese context, given the interest in measuring outcomes of social care services in Japan. Methods: The original version of ASCOT-SCT4 was translated into Japanese following good practice guidelines. Additionally, comments and feedback were obtained from an independent committee engaged in managing and providing social care services to refine the flow of sentences of the newly developed translated version. The resulting version was tested for cross-cultural validation among community-dwelling adults who use social care services to confirm the factorial structure and the scale system of the Japanese version, using Structural Equation Modeling and Item Response Theory. Results: Vigorous discussion was needed to translate the original version into Japanese especially for the items control over daily life and dignity. These two items were linguistically difficult to express in everyday language so potential participants could easily understand the intended concepts. In the cross-cultural validation, we obtained values for model fit within the acceptable range: between 0.706 and 0.550 for factor loadings, 0.923 for the Comparative Fit Index, 0.910 for the Tucker-Lewis Index, and 0.083 for the Root Mean Square Error of Approximation. This confirmed the factorial structure of the Japanese version. The IRT analysis, however, revealed that the scale system needed refinement to facilitate appropriate differentiation between each response option. Conclusions: This study provided preliminary evidence that the Japanese version of ASCOT-SCT4 is valid. As a result, the Japanese version was finalized and approved by the instrument developer

Development of Japanese utility weights for the Adult Social Care Outcomes Toolkit (ASCOT) SCT4

Purpose: In developed countries, progressive rapid aging is increasing the need for social care. This study aimed to determine Japanese utility weights for the Adult Social Care Outcomes Toolkit (ASCOT) four-level self-completion questionnaire (SCT4). Methods: We recruited 1050 Japanese respondents from the general population, stratified by sex and age, from five major cities. In the best–worst scaling (BWS) phase, respondents ranked various social care-related quality of life (SCRQoL) states as “best,” “worst,” “second-best,” or “second-worst,” as per the ASCOT. Then, respondents were asked to evaluate eight different SCRQOL states by composite time-trade off (cTTO). A mixed logit model was used to analyze BWS data. The association between cTTO and latent BWS scores was used to estimate a scoring formula that would convert BWS scores to SC-QALY (social care quality-adjusted life year) scores. Results: Japanese BWS weightings for ASCOT-SCT4 were successfully estimated and found generally consistent with the UK utility weights. However, coefficients on level 3 of “Control over daily life” and “Occupation” domains differed markedly between Japan and the UK. The worst Japanese SCRQoL state was lower than that for the UK, as Japanese cTTO results showed more negative valuations. In general, Japanese SC-QALY score (for more than 90% of health states) was lower than that for the UK. Conclusions: We successfully obtained Japanese utility weights for ASCOT SCT4. This will contribute to the measurement and understanding of social care outcomes

大都市団地居住高齢者の社会関係と生活ニーズ充足のためのソーシャルサポート ─ライフコースとケアリング関係の視点からの分析─

本研究の目的は,ライフコースとケアリング関係の視点から,大都市団地居住高齢者の社会関係と生活ニーズ充足のためのソーシャルサポートとの関連を分析し,地域包括ケアの課題を検討することである。東京都A 市B 団地居住高齢者429 名への訪問調査を2011 年5-6 月に実施した(有効N=196 名,有効回答率:46.0%)。主な結果として,1)生活ニーズのある人(全体の1 割弱)の2-4 割に支援者がおらず,有支援者の2 割弱が家事,買い物,ゴミだし,当番の場合に近所の人を担い手としてあげた(複数回答),2)困りごとの相談相手がいない人は2 割弱で,男性の方が女性よりいない割合が高い,3)ロジスティック回帰分析の結果,独居,男性,近隣ネットワークが小さい方が相談者がいない確率が高いことがわかった。独居や男性など既存の社会ネットワークを活用したソーシャルサポートの活用可能性が乏しいグループには適切な支援策が必要であることが示唆された。小規模調査の限界もあるが,団地居住高齢者の多様な社会関係とソーシャルサポートの現状をふまえての地域包括ケアの課題があきらかになった。The purpose of this study is two-fold: 1) to examine the association between social relationships and support for meeting the daily life needs of elderly people in an urban housing complex from the lifecourse and caring-relations perspectives and 2) to discuss the challenges of community comprehensive care. Structured home-visit interviews were conducted among 429 elderly people at Housing Complex B in City A, in the Tokyo Metropolitan area, from May to June, 2011. Valid responses were obtained from 196 persons, for a response rate of 46.0%. The results are as follows: 1) among the elderly who had daily-life needs (less than ten percent of total respondents), twenty percent relied on neighbors for doing housework, shopping, taking out garbage, and performing duties in the housing complex (multiple answer); 2) less than twenty percent of respondents had no one they could turn to for advice regarding their day-to-day difficulties; and 3) as a result of logistic regression analysis, single people, males, and respondents with small networks of neighbors were found to be less likely than couples, females, and those with large networks of neighbors to have anyone to turn to for advice. Our findings indicate thatit is necessary to have an appropriate support system for those who have limited support available in their existing social network (e.g. single people, males). In spite of the limitation of a small sample, we could clarify some of the challenges for community comprehensive care for elderly people by considering the diverse social relations and social support available to them in a housing complex

Towards community-based integrated care: trends and issues in Japan’s long-term care policy

<span style="line-height: 200%;" lang="EN-US">Introduction: In 2000, Japan implemented a mandatory long-term care insurance system. With the rapid growth of the system, problems became apparent. Several critical alterations were made to the long-term care insurance system, particularly with respect to integrated care. Methods: This paper elucidates the policy trends that led to the reforms of the long-term care insurance system, which included new concepts of ‘integrated care’ and ‘community-based care’, an agenda of cost containment and service streamlining, and coordination with medical care. Results: Community-based integrated care, as envisaged in the long-term care policy, includes not only the integration of medical care into service provision but also the inclusion of the informal mutual aid, oversight of for-profit providers by an administration that ensures users are not exploited and coordination between systems that cover different geographical areas. Conclusions: Japan’s experience in community-based care integration suggests that this project requires multi-faceted care integration in local communities. In the future, it will be necessary to conduct empirical assessments of the effectiveness of these measures. </span

Towards community-based integrated care: trends and issues in Japan’s long-term care policy

Introduction: In 2000, Japan implemented a mandatory long-term care insurance system. With the rapid growth of the system, problems became apparent. Several critical alterations were made to the long-term care insurance system, particularly with respect to integrated care.Methods: This paper elucidates the policy trends that led to the reforms of the long-term care insurance system, which included new concepts of ‘integrated care’ and ‘community-based care’, an agenda of cost containment and service streamlining, and coordination with medical care.Results: Community-based integrated care, as envisaged in the long-term care policy, includes not only the integration of medical care into service provision but also the inclusion of the informal mutual aid, oversight of for-profit providers by an administration that ensures users are not exploited and coordination between systems that cover different geographical areas.Conclusions: Japan’s experience in community-based care integration suggests that this project requires multi-faceted care integration in local communities. In the future, it will be necessary to conduct empirical assessments of the effectiveness of these measures