AMBO HIDEO

HAYASAKA HIROSHI

ISHII HIRONORI

OHASHI HIDESHI

English

紀要類(bulletin)departmental bulletin pape

HAYASAKA, HIROSHI

ISHII, HIRONORI

AMBO, HIDEO

OHASHI, HIDESHI

Tohoku University Repository (TOUR) / 東北大学機関リポジトリ

The Functions of "Family" in Health CareSystem: A Health Diary Study in JapaneseCities著者 HAYSAKA  HIROSHI, ISHII  HIRONORI, AMBO HIDEO, OHASHI  HIDESHIjournal orpublication titleTohoku psychologica foliavolume 50page range 62-68year 1992-05-01URL http://hdl.handle.net/10097/62530Tohoku Psychologica Folia 1991, 50, 62-68 THE FUNCTIONS OF "FAMILY" IN HEALTH CARE SYSTEM: A HEALTH DIARY STUDY IN JAPANESE CITIES By HAYSAKA HIROSHI (.If!-~lt-;=tt:;)I, ISHII HIRONORI (:fi**:!1!!;)1, AMBO HIDEO ('t(*:9t~)1 and OHASHI HIDESHI (*m~~f)1 (Tolwku University) This health diary study was carried out in two cities in Japan. 164 families (663 family members in total) participated in the study. Housewives of the families kept for 15 days the diaries about every day sickness episodes of themselves and other family members. 375 sickness episodes were reported in total. 79% of recorded sickness episodes were managed in family without receiving treatment from professional medical practioners. Most common family treatment included resting and self-medication. 21% were treated by professional practioners. The patients only received Western medicine, not Chinese medicine or folk medicine. These results are consistent with those obtained by previous study in two rural areas in Japan (Ambo et aI., 1991; Ohashi, Ambo, & Hayasaka, 1989). We therefore conclude that most of sickness experienced in everyday life are managed in family independently of available outside health care resources. This suggests that family functions as a popular sphere of health care activities in the Japanese health care system. Key words: health diary method, sickness episode, health care system, popular health care activities. PROBLEM Although modern medicine based on biomedical model is progressing increasingly at the present time in Japan, people do not necessarily follow modern medicine blindly. For example, cerebral death and organic transplantation, the result of progress of modern medicine, conflict with traditional Japanese attitudes to body and death (Namihira,1988). Some patients with mental illness seek advice both from shamans or religious group and from Western-style doctors (Imaizumi, 1991; Ohashi, Sakumichi, & Horike, 1984; Sakumichi et al., 1984). In addition, local herbs and health foods are very popular among Japanese people now. All these incidents suggest that our beliefs about health and illness are different from the concept of health and illness based on biomedical model. Kleinman, A., a psychiatrist trained in medical anthropology,has pointed out that illness as experience and its meaning is constructed in a special cultural system: the 1. Department of Psychology, Faculty of Arts and Letters, Tohoku University, Kawauchi. Aobaku, Sendai 980, Japan. The Functions of "Family" in Health Care System 63 health care system (Kleinman, 1980). This is what he has to say on the health care system: "In every culture, illness, the responses to it, individuals experiencing it and treating it, and the social institutions relating to it are all systematically interconnect-ed. The totality of these interrelationships is the health care system." In his model of health care system, the sphere of popular health care beliefs and activities is more emphasized than that of modern medicine, because illness is first defined and health care activities are initiated in the lay, non-professional culture arena. The popular sphere of health care, though least studied, is the core part in the health care system. Our concern is to examine the popular health care activities in the health care systems in Japan. Health diary method was used to collect information of daily physical and/or psychological problems. Freer (1980) has discussed advantages of health diary method. First, since health diaries are completed by patients themselves, they provide the opportunity for a more patient-centered approach. Second, the diaries provide more accurate information about daily health problems than retorospective studies. Thus, health diary is a suitable method for assessing every day health care activities in the popular sphere such as individual, family, and community. We had already conducted the health diary study in two rural area in Japan: West Tsugaru district in Aomori Prefecture and north part of Okinawa Prefecture (Ambo et aI., 1991: Ohashi, Ambo, & Hayasaka, 1989). Since urban residents have more available outside health care resources such as hospital than rural residents, they would show different daily health care activities and illness behavior. This health diary study was intended to examine health care activities among urban families. METHOD Field: The Health diary study was carried out in Tagajou City and Shiogama City, Miyagi Prefecture (Fig. 1). Tagajou City (62,000 population) is about 10 km, Shiogama City (56,000 population) is about 16 km away from Sendai City (900,000 population). Recently, Tagajou and Shiogama city became suburbs of Sendai. Consequently, many citizens of both cities work in Sendai City. Like any other region in Japan, at least Western medicine and Chinese medicine are available as health care resources in Tagajou and Shiogama. Table 1 shows the number of hospitals, Western-style clinics, Chinese-style clinics, and pharmacies in Tagajou, Shiogama, and Sendai. Though there are fewer health establishments in Tagajou and Shiogama than Sendai, it is likely that the citizens of Tagajou and Shiogama can easily use health establishments in Sendai, because both cities are included in the greater Sendai area. In addition, Ohashi, Sugiyama, and Ambo (1989) have reports that in Sendai area 43 shamans called Kamisama are engaged in fortune-telling, counseling on life problems, and healing illness, etc. Sample: 164 families (663 family members in total) participated in this study. 64 Hayasaka, H., Ishii, H., Ambo, H. and Ohasi, H. Okinawa Prefecture '. • 0(/ !l Japan Miyagi Prefecture Fig. 1. Location of Tagajou City and Shiogama City. Table 1. The number of main medical establishments in three cities. Tagajou Shiogama Sendai Total Hospital 1 6 67 74 Western-style clinic 18 55 652 725 Chinese-sty Ie clinic 23 31 492 546 Pharmacy 16 33 511 560 47% of the sample are male and 50% are female. The mean age for the sample is 39.1 (SD=22.4). 164 housewives who were asked to keep the diaries were chosen from the audience of "A Course of Lectures for Housewives" promoted by the city office of Tagajou, and from Fujikura district of Shiogama City. Procedure: This study follows the procedure in our two previous studies (Ambo et al., 1991; Ohashi, Ambo, & Hayasaka, 1989). Before they started to keep the health diary, the housewives were inquired about the condition of their family members' health, the articles for health maintenance kept at home, and preventive health behavior taken by their family members. Then they kept the health diary for 15 days. The diary consisted of a structured sheet (Fig. 2). The housewives were asked to record any health problems they and their family members had, no matter how transient or trivial those were. The Functions of "Family" in Health Care System Date _______ _ How would you rate your heal th today? Please circle the most appropriate number. L Very good Z Good 3. Poor 4. Very poor If sickness bothered you today, how serious was the sickness? Please circle the most appropriate point on the scale. I I I I I Mi ld Serious Please describe it in detail. Since when has it bothered you? l. For a long time 2 Since yesterday 3. Today How much could you do your normal activi ties? Please circle the most appropriate point on the scale. I I I I All Nothing What did you do to make yourself feel better? Please circle anything you did. L Stopping housework 2 Lying down on the bed 3. Resting a few hours 4. Taking the body temperature 5, Diet ~ ~~~~~~: or warming the body 7 Other treatment ___ _ Did you take any medicine today? !. Yes 2 No What the medicine? And what efficacy does it have? Where did you obtain the medicine from? 1 Pharmacy 2 First-aid medical box l Prescribed medicine obtained from hospital or clinic for this sickness Previously obtained prescribed medicine Homemade medicine Did you consult Western-style doctors today? L Yes 2 No Did you consult other professional practioners today? Please c i rel e any prac t i ooers you consu 1 ted. 1 Chinese-style doctors 2 Bonesetter 3 Kamisama or Ogamiya Fig. 2. The health diary sheet for housewife. RESULTS 65 Health care resources in the families: 96% of the families (n= 164) had clinical thermometer; 92% had scale; 84% had first-aid medicine box. About 30% of the families had health care implements or health foods such as a machine for massage or a processed chI orella. Reported sickness episodes: During the study period, 255(38.5%) of 663 family members experienced sickness. Sickness episodes totaled 375, exclusive of chronic illness. The types of the sickness are shown in Fig. 3. "Cold" accounted for 37% of all sickness episodes. The mean duration of the sickness was 2.3 days. Received treatment: Table 2 shows received treatment in 374 sickness episodes. One episode was excluded because it was unclearly about received treatment. 60% of all episodes involved family treatment only. Most common family treatment includ-ed resting and self-medication (Table 3). Patent medicines and previously obtained 66 Hayasaka, H., Ishii, H., Ambo, H. and Ohasi, H. 40 if> 30 <lJ ""d o if> .0. <lJ 20 "iii 'H o * 10 Symptom codes Fig. 3. Types of sickness (symptom codes l-ll) reported. It shows frequency of each symp-tom as percentage of all sickness episodes (n=375). Symptom code: 1,"cold," etc; 2, limbs pain- ; 3, headache; 4, abdominal pain; 5, tiredness; 6, toothache; 7, eye com-plaints; 8, skin problems; 9, menstruation; 10, injury; ll, other problems. - Lumbago and shoulder pain are also included. Table 2. Distibution of treatment received in sickness episode. Sickness episodes receiving no treatment Sickness episodes only receiving family treatment Sickness episodes treated by professional practioners Total sickness episodes Number 71 225 78 374 Table 3. List of common treatments used by families. Type Frequency of use (%) Resting 50.1 Self-medication Taking temperature Diet Cooling or warmin body 44.8 17.3 11.5 9.6 Percentage 19.0 60.2 20.8 100.0 prescribed medicines tended to be used on self-medication. Only 21% of all sickness episodes were treated by professional practioners, all of whom were Western-style doctors. Applying x2-test, we found that the types of symptom (x 2=42.2, p<.Ol), perceived severity (x 2 =65.7 p<.Ol) and duration of sickness (x 2 =59.3 p<.Ol) were significantly related to received treatment. While headache and tiredness were as-sociated with receiving only treatment from family, sickness episodes of longer duration and of greater perceived severity were associated with receiving treatment The Functions of "Family" in Health Care System 67 from Western-style doctors. DISCUSSION When we include the sickness episodes that received no treatment, 79% of all sickness episodes were managed in family without consulting professional practioners. In our two previous studies in Aomori and Okinawa, the frequencies of sickness episode maneged in family were 82%(n=464) and 83%(n=382) respectively (Ambo et al., 1991; Ohashi, Ambo, & Hayasaka, 1989). Thus, there was no great difference in the frequencies in the three areas, though fewer people recorded sickness episodes in this study. In addition, a variety of health resources and treatments were provided in the families. We can see from these results that most of sickness experienced in everyday life are managed in family independently of available outside health care resources. This suggests that family as a popular sphere of health care activities plays an important role in managing everyday sickness. Sickness of longer duration or of greater perceived severity were associated with receiving treatment from Western-style doctors. When a sickness was perceived as unmanageable in family, the patient tended to receive Western medicine, not Chinese medicine or folk medicine. The previous two studies also found this tendency. Thus, ordinary Japanese seem to have faith in Western medicine. This indicates that Western medicine is established as a social institution. However, in the case of difficult to treat and chronic illness, it is likely that patients receive Chinese medicine or folk medicine besides Western medicine as Kleinman (1980) has shown in his studies in Taiwan. He has pointed out that such illness behavior is based on the prospect of symptom relief and beliefs about cause and severity of the illness, which are prescribed in the lay, non-professional culture arena. Even if the health diary is adequate for collecting information about everyday sickness episodes, this method may be inade-quate for examining the issues of popular health care activities concerning chronic illness. We need to adopt a different approach to assess illness behavior of chronic illness patients in the health care system of Japan. REFERENCES Ambo, H., Hayasaka, H., Ishii, H, & Ohashi, H. 1991 Health-related behavior and health care system in Okinawa. The Bulletin of Student Counseling Center in Tohoku University, 18, 39-53. Imaiuzmi, T. 1991 A clinical study of schizophrenia associated with new religion in Japan. Psychiatria et Neurologia Japonica, 93, 371-402. Kleinman, A. 1980 Patients and healers in the context of culture: A n exploration of the borderland between anthropology, medicine, and psychiatry. Berkeley: University of California Press. Freer, C.B. 1980 Health diaries: A method of collecting health information. Journal of the Royal College of General Practioners, 30, 279-282. Namihira, E. 1988 Cerebral death, transplantation: A medical anthropological approach. Fukutake Shoten. (in Japanese) 68 Hayasaka, H., Ishii, H., Ambo, H. and Ohasi, H. Ohashi, H., Sakumichi, S., & Horike, K. 1984 A social psychological study of Okinawan shamanism (I) : Approach and some findings. Tolwku Psyclwlogica Folia, 43, 66-79. Ohashi, H., Ambo, H., & Hayasaka, H. 1989 Self-care to unwellness episodes: A survey by health diary method. The Japanese Joornal of Health BehavioTal Science, 4, 33-47. Ohashi, H., Sugiyama, S., & Ambo, H. 1989 Shamans in the Tohoku Area [II]. Report of the Research Institute for Japanese Culture, supplement 26, 168-184. Sakumichi, S., Ohashi, H., Horike, H., & Tohyama, N. 1984 A social psychological study of Okinawan shamanism (II): An investigation of the health-seeking process in the traditional society under the infiltration of modern westers culture. Tolwku Psyclwlogica Folia, 43, 80-90. (Received October 14, 1991) (Accepted November 30, 1991) 

The Functions of "Family" in Health Care System: A Health Diary Study in Japanese Cities

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The Functions of "Family" in Health Care System: A Health Diary Study in Japanese Cities

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