Yoshioka-Maeda Kyoko, Fujii Hitoshi, Shiomi Misa, Katayama Takafumi, Hosoya Noriko, Mayama Tatsushi
Department of Health Promotion, National Institute of Public Health.
School of Nursing, Mejiro University.
Nihon Koshu Eisei Zasshi. 2021 Dec 24;68(12):876-887. doi: 10.11236/jph.21-010. Epub 2021 Oct 22.
Objective The aim of this study was to elucidate the status of health-care, medical, and welfare planning (hereafter, "planning")-in which public health nurses (PHNs) had participated-and the factors associated with community collaboration in the implementation phase. Additionally, suggestions regarding health activities that would contribute to improving the entire community's health level were obtained.Methods The Plan-Do-Check-Act (PDCA) cycle was the conceptual framework for this study, and the focus was the implementation phase of the plan (i.e., corresponding to the "Do" phase). Survey items were part of the "Plan" phase and identified the extent to which PHNs collaborated with community-dwellers in implementation, their demographics, their participation in the planning process, organizational factors, and the strategies used in the planning phase. The participants were full-time PHNs working in local governments who had participated in the planning process since 2013 (when the guidelines for PHNs' practices were published). A nationwide, cross-sectional survey was conducted in Japan with 2,185 PHNs from 220 regions (36 prefectures, 41 cities with public health centers, and 153 municipalities) who expressed the willingness to participate in this study. A binomial logistic regression analysis was conducted to examine the association between community collaboration and the independent variables.Results A total of 1,281 answers (a 58.6% response rate) were received. Ultimately, 1,028 (a 47.0% valid response rate) were analyzed; exclusions were 203 for no experience in health care planning since 2013 and 50 with missing values. There were 125 (12.2%) PHNs who answered that they "did not collaborate with the community-dwellers at all," 293 (28.5%) who answered that they "did not collaborate with them much," 482 (46.9%) who replied that they "collaborated with them a little," and 128 (12.4%) who responded that they "collaborated with them a lot." The binomial logistic regression analysis showed that the following were associated with PHNs' collaboration with the community: being in a managerial position, having experience developing a health promotion plan, conducting a questionnaire survey or group work, as well as participating in municipal health planning committees with community-dwellers, utilizing research evidence, identifying target groups, and managing the plan's progress.Conclusion From the planning phase, PHNs must collaborate with community residents and reflect their voices so that the formulated plan will help resolve medium to long-term issues in the community related to health and life.
目的 本研究旨在阐明公共卫生护士（PHN）参与的医疗保健、医疗及福利规划（以下简称“规划”）的实施状况，以及实施阶段社区协作的相关因素。此外，还获取了有助于提高整个社区健康水平的健康活动建议。
方法 本研究以计划-执行-检查-行动（PDCA）循环为概念框架，重点关注计划的实施阶段（即对应“执行”阶段）。调查项目属于“计划”阶段，旨在确定公共卫生护士在实施过程中与社区居民协作的程度、他们的人口统计学特征、参与规划过程的情况、组织因素以及规划阶段所采用的策略。参与者为自2013年（《公共卫生护士实践指南》发布之年）起参与规划过程的地方政府全职公共卫生护士。在日本对来自220个地区（36个县、41个设有公共卫生中心的城市以及153个市）的2185名表示愿意参与本研究的公共卫生护士进行了全国性横断面调查。进行二项逻辑回归分析以检验社区协作与自变量之间的关联。
结果 共收到1281份回复（回复率为58.6%）。最终，分析了1028份回复（有效回复率为47.0%）；排除了203份自2013年以来无医疗保健规划经验的回复以及50份有缺失值的回复。有125名（12.2%）公共卫生护士回答他们“根本没有与社区居民协作”，293名（28.5%）回答他们“与社区居民协作不多”，482名（46.9%）回答他们“与社区居民有一点协作”，128名（12.4%）回答他们“与社区居民有很多协作”。二项逻辑回归分析表明，以下因素与公共卫生护士与社区的协作相关：担任管理职位、有制定健康促进计划的经验、进行问卷调查或小组工作、与社区居民一起参与市卫生规划委员会、利用研究证据、确定目标群体以及管理计划进展。
结论 从规划阶段开始，公共卫生护士就必须与社区居民协作并反映他们的意见，以便制定的计划有助于解决社区中与健康和生活相关的中长期问题。
