KawasakiJourna
lofMedica
IWel
f
a
reVo
l
.20
, No
,1
, 201431‐41
1or
i
g
i
na
ーPaper三
Health SupportProvided
by Public Health
Nurses
for
卦4iddle‐aged
Recipien」ts
ofPubl
i
c
Assistance
Living
at
Ho]mーe
sanae
TOM[
IT‐A
*
and Kazuko
M【
ITOKU**
催c
c勿r
edル〃e20
,2似の
Key
words:heal
th
problems,hea
l
thsupport
,mi
dd
l
e
‐
age
,publ
i
c
assistancerec
i
p
i
ent
s
,pub
l
i
chea
l
th
nurse AbstractTh
i
s
studywa
s
conducted to examinethere
l
a
t
i
onsh
i
p
betweenhea
l
th problemsin middle‐aged
recipientso
fpubl
i
c
assistancel
i
v
i
ng
athome and
awarenesso
f
these problemsby publ
i
c hea
l
th
nurses. Surveyitemsi
nc
l
udedthebas
i
c
attributeso
f
35
3
pub
l
i
c hea
l
th
nursesandthe
i
r
awarenesso
f
heal
th
problemsi
n midd
l
e
‐
aged
recipientso
fpubl
i
c
assistancel
i
v
i
ng
athome
.The
nurses wered
i
v
i
dedintotwo
groups according totheleve
loftheir
awareness,andlogistic regression analysiswa
sconduc
t
ed wi
ththetwolevel
so
f(
h
i
ghandl
ow)awarenessasdependentvar
i
ab
l
es
.
Va
l
i
d
responseswereco
l
l
ec
t
edf
rom
2
06
nur
ses(
va
l
i
dresponserate
:63
.
2%)
.Thef
o
l
l
owi
ng
nurses recognizedthat middle
‐
aged
recipientsofpubl
i
c
assistance have a numbero
fheal
th
problems: thosewho
worki
n
government‐ordinance‐designated and majorurban citiesandtowns;collaboratewi
th soc
i
a
l
workers; and considerthatthe heal
th
needso
fthe
recipientso
fpubl
i
c
assistanceshou
l
dbe
understood.Publ
i
chea
l
th
nurses’awarenesswa
s
notcorrelatedwi
ththe
i
r
age,yearso
f
experience,andwhether
or nottheyhad
experienceo
fproviding
public assistancerecipientswi
th
support.l
ti
s
necessary toimplement
educationwi
th
an emphasis onthe
weakand
improvethesk
i
l
l
sof
pub
l
i
chea
l
th
nurses workingi
n mun
i
c
i
pa
l
i
t
i
esbyprovidingthem wi
th
support.1.lntroduction
The Wor
l
d Heal
th
organization(WHO
)
and UN Human
SettlementsProgramme(UN‐HAB工TAT)joint
l
y
presented a reportwi
ththe globaltheme:”Hidden
imageso
fc
i
t
i
es
: Wi
th the a
im
of reducinghea
l
th
d
i
spar
i
t
i
es
”
. Accord
i
ng
tothi
s
report,illnessesand
otherhea
l
th
problems are more serious amongthe
poorl
i
v
i
ngi
n
urban areas,andhea
l
th d
i
spar
i
t
i
es
area
t
t
r
i
buted
tosoc
i
a
l
statusandthel
i
v
i
ng
environment.工
t
suggeststhatloca
l
governments are responsiblef
or
reducingd
i
f
f
erencesi
nthel
eve
lofheal
th among
commun
i
tyres
i
dents[
1
]
.
Art
i
c
l
e25o
fthe
Constitution ofJapan guarantees allpeopletherightto maintainthe minimum standard *DepartmentofNursing,FacultyofHealthandwrelfare,KawasakiUniversityofM[edicalw了elfare, Kurashiki,okayama701‐0193,Japan E‐M【ail:tomita@mw.kawasaki−m.ac.〕p ** UniversityofHumanEnvironments,okazaki,Aichi444‐3505,Japan 31Sanae
Tomi
t
aand
KazukoD
江
i
t
oku
32 anae oo
fl
i
v
i
ng
,i
nc
l
ud
i
ngthe publ
i
c
assistance system for peoplei
n
poverty. Underth
i
s
system,a survey ls conducted to examinethel
i
v
i
ng
conditionso
f
an applicantf
or
assistance,including savingsand whe
ther
theappl
i
canti
si
l
l
/
i
n
juredorabl
et
o work
,andtheperson w
i
l
lbeprovided wi
thpubl
i
c
assistancei
fh
i
s/her
incomei
s
lowerthanthe
amountrequiredto maintainthe minimum standardofl
i
v
i
ng
asstipulatedi
nthe
constitution.Publ
i
c
assistancei
sc
l
a
s
s
i
f
i
edi
nt
oe
i
ghtt
ypes
,i
nc
l
ud
i
ng
assistanceforliving,education,housing,and hea
l
th and
nursing care,and
standards have beenes
tabl
i
shedf
or
eacho
fthem [
2
]
.For
example,asf
orthe mi
n
imum standardfor
monthlypub
l
i
c
assistancef
or
one seto
ff
ami
l
i
es wi
th twochi
l
dren,itis
235
,
040
yenf
orl
i
ve
l
i
hood
assistance,education assistanceand
housing assistancei
n
af
i
r
s
t
classp
l
ace[
3
]
.
According
to a2004
survey conductedbythe∼l
i
n
i
s
t
ryofHea
l
th
,Labouran
d下
フ
ve
l
f
a
re
,theamounto
fpubl
i
c
assistancei
nJapani
sre
l
a
t
i
ve
l
y
large compared tothe
income supporti
n Br
i
ta
i
n and publ
i
c
assistance・n otherdevel
opedcountr
i
es[
4
]
.However
,th
i
sdoesno
t meanthatthequa
l
i
tyofl
i
f
e(QOL
)o
fpubl
i
cas
s
i
s
tance
recipients(
PARS
)i
s h
igh.Sincethe
positiono
fthepubl
i
c
assistance systemi
n
a country depends oni
t
s
re
l
a
t
i
onsh
i
p wi
ththe
socialsecurity systemo
fthat
country,therei
s
no pointso
l
e
1
y
comparing thepub
l
i
c
assistancesystemso
fd
i
l
ヨ
…
erent
countrieswi
thoutdi
scus
s
i
ngthemin
relation tothesoc
i
a
l
security systems‐工n
fact,recipientso
fpubl
i
c
assistancei
njapan
arerequiredto undergo a meanstest,and some ofthem
ares
t
i
gma
t
i
zed
,accor
d
i
ngtoareport[
5
1
.
工n recent years,there have beens
i
gn
i
f
i
cant
changesi
n
japanese societyand
economy,including ag・ngo
fthe
population,subsequent decreasei
nthe
workforce,and changesi
nthe
system of employment,such as an increasei
n the
numbero
f
contractempl
oyees[
6
]
.ln
response to thesesoc
i
a
l
changes,therehas
been a steady increasei
nthe
numbero
f
recipientso
fpubl
i
c
assistance. There were approxilnLatelyl
.
95
mi
l
l
i
onPARsi
n2011
,wh
i
ch wa
sl
.
52% oroneinapproximately66japanesepeople[
2
]
.Thera
t
eo
fi
ncrea
se
i
nthe
numbero
f
recipientso
fpubl
i
c
assistancedur
i
ngtheper
i
od
between200
0
and 2010f
orthe
“otherhousehold
”
groupwas
approximately2
.
2
,the h
i
ghes
t
recorded,due to the continuing recession[
7
]
.
The
largestpropor
t
i
on
,or26
.
5%,ofPARscited
”
i
l
l
nessori
n
jurytotheheadofthehouseho
lぜ
asthereasonf
or
t
he
i
r
needf
oras
s
i
s
tance(September2010
)[
2
]
.Accord
i
ngtoasurvey(
2007Surveyon Medi
ca
IAss
i
s
tance
)
,
the
largest proportiono
fPARS
receivedmed
i
ca
l
assistancef
or menta
l
/behaviora
ld
i
sorder
s
,f
o
l
l
owed by
thatf
orcard
i
ova
scu
l
a
rd
i
sorder
s{
8
]
.
工njapan,
there arepub
l
i
chea
l
thnurses(PHNS
)whosupportthehea
l
thofcommuni
tyres
i
dentsincluding
peop1ei
n
poverty. ThePH 寸
,de
f
i
nedi
nthe Ac
t
onp日Ns
, 1
i
dwives
,and
Nurses asthe governing1
aw,is
aheal
th
professional.People,basically nurses, who have completed coursesre
l
a
t
ed
topubl
i
c hea
l
th
nursingand
passedthe
nationalexamination arecer
t
i
f
i
ed
asPHNs
.The Quad Counc
i
lofPubl
i
c Hea
l
th
Nursing organizationso
fthe Amer
i
can Pub
l
i
c Hea
l
t
h
Associationdef
i
nespubl
i
c hea
l
th
nursing as,“An activity to promotethe hea
l
th of
groupso
f
peopleandthe
i
r
protection,based on aknowledgein
nursing,sociology,andpubl
i
chea
l
tげ [
9
1
.PHNs
are alsorequiredto beab
l
et
oi
dent
i
f
yhea
l
thproblemsinthecommuni
tyand
develop
measuresforheal
th
promotion. Asadmi
n
i
s
t
ra
t
i
ve
servlceprov
i
ders
,PHNs
can respond tohea
l
th
,
orsocial,problemsf
acedbyPARS1
i
v
i
ngi
nthecommun
i
tyandprovidethem wi
thhea
l
th
support.As middle‐aged
recipientso
fpubl
i
c
assistanceoften haved
i
f
五cul
ty
gainingemployment,few ofthem
have opportunitiesto undergo regularhea
l
th
check‐upsi
n workpl
aces
.Wr
hen
they becomei
l
l
,they areprov
i
ded
wi
th med
i
ca
l
assistance underthepubl
i
c
assistance system.Peoplewi
th psychol
ogi
ca
l
or other problemsmay
receive supportf
rom
PHNS. However, whenthe hea
l
th ofPARsi
s d
i
scussed
from the viewpointo
f
preventive care,problems cans
t
i
l
l
remaini
nthef
i
e
ldsofhea
l
th
promotion (primaryprevent
i
on
)and
supportfortheprevention/earlyidentification ofdisorders(secondary prevention).A summaryof
previouss
tudi
es
onthehea
l
th
supportprov
i
dedforPARsi
s
asfollows: A previousstudy usingSF‐
8
1
10
]
suggestedthatthe hea
l
th
‐
re
l
a
ted(HR)(
phys
i
ca
land psychological
) QOL of midd
leaged
recipientso
fpubl
i
c
assistancei
ss
i
gn
i
f
i
cant
l
y
lowerthantha
tofthe
generalpub
l
i
c
,andtha
ti
t
is necessary toprov
ide
appropriatehea
l
th
informationava
i
l
ab
l
ei
nthecommun
i
ty and
supportre
l
a
t
ed
to nutritionand
resttoincreasethe
HRQOL{
11
]
.A
previous study onthe hea
l
th behavi
orso
f middleaged
recipientso
f
pub
l
i
c
assistancel
i
vi
ng
athomef
oundtha
tthe
i
r
smoking ratewa
s h
i
gh
;there
weref
ew
normal‐weight33
SupportforPubl
i
c As
s
i
s
tance
Recipientssub
ject
sand mos
t
were obese orth
i
n
;and
they,even those with hypertension orotherd
i
sorder
s
,had
notdeve
l
opedhea
l
thybehavior[12]
.Fur
thermore
,al
argernumberofPARssu茸eredf
rom a
l
coho
l
i
sm and
otheradd
i
c
t
i
ons
,
comparedto generalcom munity residents【13],and they required carefulsupport becausemos
t
o
fthem
weres
i
ng
l
eandhadl
imi
t
edsoc
i
a
lnetworks[
14
]
.Accord
i
ngtotheresul
t
so
fthesepreviousstudies
,
thehea
l
thcondi
t
i
onso
fPARs
are worsethan thoseo
f
other people,andthei
r
problems,such asadd
i
c
t
i
on
,
aremored
i
f
f
i
cu
l
t
toresolve.No
studies have been conductedto examinethe
statuso
f
supportprov
i
ded
forPARsby municipaIPHNS
,
aswe
l
l
asthe
i
r
awarenesso
fthi
s
issue,a
l
though
there have beensome
related studies:aqua
l
i
tat
i
ves
tudy
onthefunctiono
fpubl
i
c
health nursing wasd
i
scussedba
sedon
exampleso
fthe
activitieso
fPHNSass
i
gned
aspub
l
i
c
assistance counselors[
15
]
and
as
tudyontheski
l
l
so
fPHNS workingin wel
f
areo茸
i
ces
to suPportpeop
l
ei
npoverty[
16
]
.
Thef
o
l
l
owi
ngf
i
nd
i
ngs
wereobta
i
ned
:
there has been anincreasei
nt
he
numbero
fPARS
− particularlyhouseho
ldsincluding middleaged
recipientsc
l
ass
i
f
i
edi
ntothe
“othe
group;theHRQOL
and hea
l
th
conditionso
fPARs
are poorerthan
thoseo
f
other people,and measuresf
or
lifestyle‐related diseasesshou
ld
be
implemented;there are problemsi
n
relation tohea
l
th
measuresf
or PARS
;andf
ew s
tudi
es
have been conducted onthe act
i
v
i
t
i
eso
fPHNs
forPARS
.The
present study,involvingmuni
c
i
pa
IPHNS
,a
imed
to examinethere
l
a
t
i
onsh
i
p
betweenheal
th
problemsf
aced by middl
e
‐
aged
recipientso
fpubl
i
c
assistancel
i
v
i
ng
athomeandPHNS
’
awareness,and
tohelpdevelop
measurestoimprovehea
l
thsupportforPARS
.
2.Methods
Thesubjects
were512 PHNS
workingi
n
a prefecture aso
f May l,2011. Mayorsfrom 2l ofthe27
mun
i
c
i
pa
l
i
t
i
esi
nth
i
s
prefecture consented to participatei
nthe
study,and survey forms wered
i
s
t
r
i
buted
tothem.Thesubjects
werea
l
IPHNsinthe21 munic
i
pa
l
i
t
i
es
,exc
l
ud
i
ng
thosewho had
taken aleaveo
f
absencesuch asch
i
l
dcareleave
.
An
anonymous se1f−comp1eted questionna.re surveywa
s
conducted between Februaryand M[
a
rch 2012
.
The municipal
i
t
i
es
wereasked
tod
i
s
t
r
i
bute
survey forms tothe PHNS
,andthey
sent backthe
formsd
i
rec
t
1
ytothe
university by mail. Surveyitemsi
nc
l
udedtheba
s
i
c
attributeso
fPHNS(
sca
l
eo
fthe municipal
i
tyin whichthey worked
,age
,
yearso
f
experience asPHNs
,and h
i
ghes
tl
eve
lof
academicbackgroundinthei
rspec
i
a
l
ty)
,spec
i
f
i
chea
l
th
supportprov
i
dedforPARS
,PHNS
’
awarenesso
fhea
l
th
problemsf
aced by PARsand hea
l
th
supportf
or
them,andd
i
f
f
i
cu
l
typrovidingsupport
.
Ci
t
i
esand
townsi
n wh
i
chthePHNs
work werec
l
a
s
s
i
f
i
ed
intothree groups accordingtothescaleo
fthe
mun
i
c
i
pa
l
i
ty
1) government‐ordinance‐designatedc
i
t
i
es wi
th
a population of morethan500
,
oooand
urbanc
i
t
i
es wi
th
a population of morethan 300
,
000
,(
2
)c
i
t
i
estha
t
have not beendes
i
gna
t
ed
,and(
3
)t
ownsand
v
i
l
l
ages wi
th
asma
l
l
population.Academic
backgroundsi
n
nursing werec
l
a
ss
i
f
i
edi
nt
o
graduate schools, unlversity,specialtiesi
n
juniorcolleges,andtechnicalcolleges.PHNs
werea
sked whe
ther
or nottheyhad
experienceo
fprovidingPARswi
thhea
l
th
support,regardlesso
fthe
i
rage
.PHNs whohadprov
i
dedhea
l
th
support werethenasked whether
or nottheyhad
experienceofvi
s
i
t
i
ngthe
homesof
patientswi
th
psychiatricd
i
sorders
,co
l
laborat
i
ng wi
th other
professionals toimplement
case studies,and
conductingt
o
ta
lhea
l
th
managementf
or PARS
,i
nc
l
ud
i
ngthe
developmento
f
approachestohe
l
pthem
consult physiciansand
understandthe
i
rhea
l
th cond
i
t
i
ons
.The
presentstudya
imed
toexaminePHNS
’
awarenesso
fhea
l
thproblemsfacedby middle‐agedrec
i
p
i
ent
so
fpubl
i
c
assistancel
i
v
i
ng
at home,based
on previous studies[
12
]
.
A
surveyi
nc
l
ud
i
ngthef
o
l
l
owi
ng
tenitemswa
s
conducted:Sanae