Cancer information seeking and scanning behavior among Nepalese migrants in Japan and its association with preventive behavior

Barriers and facilitators for healthcare access among immigrants in Japan: a mixed methods systematic review and meta-synthesis

Background

While Japan provides universal healthcare, immigrants may experience hampered access to healthcare. A comprehensive review of immigrant healthcare access is also lacking. This systematic review aims to examine barriers and facilitators of healthcare access among immigrants in Japan.

Methods

We searched for literature published in English and Japanese until January 9, 2024. Studies were included if they assessed factors influencing any stage of immigrants' healthcare access, such as perceiving needs, seeking, reaching, utilizing healthcare and the consequences of healthcare, as defined by the Levesque framework. We performed a thematic analysis to further identify categories (PROSPERO: CRD42023418554).

Findings

After screening 2791 articles, we identified 67 studies (40 quantitative, 23 qualitative, 4 mixed methods) meeting eligibility criteria. Limited healthcare information led immigrants to seek alternative information sources and affected immigrants' perceived healthcare needs. Longer duration of stay improved access to healthcare information. Cultural and healthcare system differences affected healthcare seeking. Reaching and utilizing healthcare were hindered by heavy workloads, undocumented status, financial hardship, and limited insurance but were facilitated by support from family and friends. The healthcare system was often insufficient to support immigrants' language and cultural needs leading to dissatisfaction and poor compliance.

Interpretation

Findings highlight the critical importance of a multidimensional approach to support immigrants in Japan, ranging from improving healthcare information access to creating immigrant-friendly health systems. More research is needed on the healthcare access among vulnerable immigrants, such as undocumented and low-skilled labor immigrants and children.

Funding

No specific funding source supported this study.

Online cancer information seeking and colorectal cancer screening in China: Considering threat and coping Appraisals, and cancer fatalism

Background

Colorectal cancer is major public health concern in China. This study seeks to explore the role of online cancer information seeking in influencing colorectal cancer screening, by taking into account one's coping appraisals (i.e., self-efficacy, response efficacy), threat appraisals (i.e., perceived severity, cancer worry) and cancer fatalism.

Methods

A cross-sectional survey was conducted with 730 participants in China recruited from a Chinese survey company's online panels. Path analysis was performed to investigate the relationships between the key constructs.

Results

First, online cancer information seeking increased both coping appraisals and threat appraisals. Second, threat appraisal did not significantly influence cancer fatalism, but coping appraisal reduced cancer fatalism. Third, cancer fatalism had no effects on colorectal cancer screening. Lastly, online cancer information also had a direct and positive relationship with cancer screening.

Conclusions

This research emphasises the need for health organisations to offer timely cancer information to people, and educate them about the importance of cancer screening. Health authorities may also regulate online cancer information to ensure that the information is accurate and appropriate in improving people's cancer prevention and cancer screening knowledge.

Characteristics of Vulnerable Foreigners in Need of Emergency Care Support in Japan: A Case Study of Thai Nationals from 2004 to 2020

In Japan, a considerable number of foreigners encounter challenges in accessing appropriate healthcare services due to the lack of insurance coverage. However, the absence of a public database on these individuals makes it difficult to assess their health problems and healthcare access status. This study aims to investigate the characteristics of vulnerable Thai patients in Japan and to shed light on the specific challenges they face within Japan's healthcare system. A retrospective analysis was conducted using records of patients who required emergency healthcare support from the Royal Thai Embassy in Tokyo between 2004 and 2020. Descriptive statistical analyses were performed to examine the general characteristics, insurance status, and diseases of the patients. Additionally, patients were classified as either prolonged residents or brief residents based on their duration of stay in Japan until hospital admission (1 year or more or less than 1 year). A total of 74 patients were identified, with the majority (91.9%) lacking insurance coverage. Notably, there was an increase in the number of brief residents, including tourists, during the 2010s. Prolonged residents were more likely to experience chronic diseases, whereas brief residents were more prone to sustaining injuries. The patient records from the Thai Embassy consistently highlight the urgent requirement for emergency healthcare support within this population. However, the existing policies in Japan fall short in adequately addressing the healthcare access needs of this vulnerable population. Therefore, it is crucial to provide additional support and interventions to enhance their healthcare access.

Risk Perception and Preventive Behavior During the COVID-19 Pandemic : Testing the Effects of Government Trust and Information Behaviors

Given the absence of COVID-19 treatments, the best way to control the spread of the virus is to break the chain of infection by increasing public participation in preventive behaviors recommended by health authorities. This study proposes a moderated mediation model of information behaviors (e.g. information seeking and information verification) and trust in government that explores the relationship between risk perception and preventive behaviors regarding COVID-19. Using a survey study in South Korea, we conducted the moderated mediation analysis with latent moderated structural equation modeling (LMS). We found serial mediation effects for risk perception, information behaviors, and preventive behaviors, as people both seek out information and verify that information before adopting preventive behaviors. Additionally, trust in government moderated information behaviors in the relationship between risk perception and preventive behaviors, suggesting that trust in government encourages people to adopt more preventive actions via information seeking and information verification. Further implications are discussed to promote public understanding of the health crisis and public participation in preventive measures.

Exploring physical activity experiences, barriers, and facilitators among individuals of South Asian heritage living with and beyond cancer

OBJECTIVES

The purpose of this study was to understand the physical activity (PA) experiences, as well as preferences, barriers, and facilitators to exercise, among individuals of South Asian heritage diagnosed with cancer.

DESIGN

A qualitative descriptive design was used. Individuals of South Asian heritage were recruited via a mix of convenience sampling and purposive sampling, with outreach via radio, posters in community settings, and from outreach to participants in current exercise oncology studies. Inclusion criteria included being over the age of 18; diagnosed with any cancer type and stage; pre, during, or post-treatment; able to speak English, Hindi, or Punjabi; and self-identified as South Asian. Data for this study was collected via semi-structured interviews conducted in the participants language of choice. Interviews were transcribed verbatim in the original language and then analyzed using conventional content analysis. For non-English interviews, the codes created through analysis were subsequently translated into English, and back-translated into the original language, to ensure accuracy. These codes were then organized into themes and categories.

RESULTS

Eight participants were recruited, with 5 interviews conducted in Punjabi and 3 interviews in English. The three themes that were created from the participant interviews include: (1) Culture, (2) Informational Needs, and (3) The Nature of Exercise Oncology Interventions. Within these themes, categories included barriers and facilitators to PA, as well as PA needs.

CONCLUSION

Participants' perspectives provided insights into the PA experiences, barriers, facilitators, and needs of people of South Asian heritage living with and beyond cancer. These results can be used to inform the tailoring of exercise oncology resources to better support physical activity and exercise for this population.

A Scoping Review on the Status of Female Breast Cancer in Asia with a Special Focus on Nepal

This study aimed to provide updated evidence on the status of female breast cancer and cancer treatment facilities in Asia, with a special focus on Nepal. This review used search phrases that included, breast neoplasm or cancer, health status, epidemiology, breast cancer survivors, cancer care facilities, Asia, Nepal. Researchers examined databases from January 2011 to December 2020 (PubMed, PMC, Google Scholar, and the reference lists of included papers). Studies of any design and reviews, were included in the study, except for qualitative studies. The study findings are presented in a narrative synthesis format using Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews. An initial search resulted in 974 papers, and 896 were reviewed after being checked for duplication using the Zotero software. Accordingly, utilizing the inclusion and exclusion criteria, 188 publications were selected, and after review of titles and abstracts, an additional 98 papers were removed for different reasons. Finally, the study looked at 90 female breast cancer papers. Results showed that the number of cases of breast cancer is growing all around the world, including in Asia and Nepal. Age, early menarche, late menopause, nulliparity, positive family history, excessive fat consumption, alcohol, and smoking are all frequent risk factors for breast cancer found in Asian women. Breast self-examination, clinical breast examination, and mammography screening are common methods for detecting breast carcinoma. Chemotherapy, radiation, and modified mastectomy are commonly used options for treatment. The number of breast cancer survivors is growing throughout the world, indicating better clinical care. There is a paucity of survival data in many Asian countries, including Nepal. There is also a scarcity of health workforce specialized in cancer care and treatment, as well as a few health facilities that are available to treat cancer cases in many Asian countries, including Nepal.

Health shocks and changes in preventive behaviors: Results from the China Health and Retirement Longitudinal Study

Background

China is facing the challenge of rising prevalence and ballooning burden of chronic non-communicable diseases (NCDs); however, the Chinese middle- and older-aged population considerably lack preventive behaviors. Health shocks (HS), widely defined as sudden health deterioration brought on by diseases or accidents, bring a “teachable moment” to motivate changes in preventive behaviors.

Objective

This study aims to examine the effect of HS on changes in preventive behaviors, including personal health practices and preventive care utilization.

Methods

HS was defined as any five chronic disease diagnoses (cancer, heart disease, stroke, diabetes, and hypertension). The impacts of HS on smoking, drinking, and exercise, physical examination were estimated. The panel data of 13,705 respondents were obtained from the latest two waves of the China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018. A multilevel propensity score match difference-in-difference (multilevel PSM-DID) model was constructed.

Results

HS significantly decreased smoking (OR = 0.59, p < 0.05) and drinking (OR = 0.62, p < 0.01) and increased the utilization of auxiliary inspection in physical examination (OR = 1.19, p < 0.1). Major HS had significantly considerable and specific effects on reducing smoking and drinking (OR = 0.37 and 0.56, p < 0.01), while minor HS had relatively small effects on reducing smoking (OR = 0.74, p < 0.05) and drinking (OR = 0.69, p < 0.01), but extensive effects on initiating exercise (OR = 1.32, p < 0.05), physical examination (OR = 1.18, p < 0.1), and auxiliary inspection (OR = 1.30, p < 0.05).

Conclusion

After HS, there is a teachable moment to promote positive changes in preventive behaviors. Guided by the 5A's brief intervention model (Ask, Advise, Assess, Assist, Arrange), tailored interventions should be targeted at these populations to reduce the risk of the progression and complications of existing diseases, prevent the related comorbidity, and prolong the expected life-span.

Explaining education-based difference in systematic processing of COVID-19 information: Insights into global recovery from infodemic

Systematic processing helps individuals identify misinformation during the COVID-19 pandemic and serves as an individual-level measure to fight the infodemic. Highly educated people tend to engage in systematic processing more than their less educated counterparts. We follow a major part of the risk information seeking and processing (RISP) model to explicate this gap. An online survey (N = 1,568) conducted during the early stage of the pandemic in China showed that current knowledge and perceived information gathering capacity both positively mediated the association between education level and systematic processing. Although informational subjective norms were positively associated with systematic processing, we did not observe a significant difference in these norms between highly and less educated individuals. The results clarify the psychological mechanism underlying the education-based difference in systematic processing of the COVID-19 information and corroborate a relevant part of the RISP model. Moreover, our findings offer practical implications for facilitating individuals with less educational attainment to engage in systematic processing, thereby alleviating the negative impact of exposure to misinformation on them. These insights not only apply to managing the infodemic in China, but also inform the global recovery from the infodemic.

COVID-19 Vaccine-related Information Seeking and Scanning: A Test of Mediators between Information Acquisition and Vaccination Intention among Unvaccinated Black Americans

Health information seeking and scanning are two important information acquisition strategies that can influence subsequent health behaviors. This research was contextualized in COVID-19 vaccinations and examined the effects of information seeking and scanning on vaccination intention among unvaccinated Black Americans (N = 1,278). Moreover, this research conceptualized perceived risk and efficacy as the intervening factors for the relationship between information acquisition and behavioral intention. The results indicated that information seeking had a significant effect on vaccination intention, whereas information scanning had no effect. Perceived susceptibility and response efficacy mediated the relationship between information seeking and vaccination intention. The proposed mediators did not mediate the relationship between information scanning and vaccination intention. Theoretical and practical implications are offered.

Explicating the health-related digital divide: A mediation mechanism between education level and online cancer information seeking frequency among Chinese adults

In China, highly educated adults seek online cancer information more frequently than less educated adults. This health-related digital divide may impede the less-educated from effectively preventing cancer. To explicate the divide, we introduce informational subjective norms (ISN) and information sufficiency threshold (IST) as two socio-psychological mediators between education level and online cancer information seeking (OCIS) frequency. ISN represents one's perceived social pressure about seeking cancer information, while IST manifests individual evaluation of the amount of information needed to prevent cancer. An online survey supported a serial mediation effect of ISN and IST. ISN and IST also independently mediated the relationship between education level and OCIS frequency. Besides, the mediation effect of ISN was stronger than that of IST. The findings suggest that increasing ISN among less educated Chinese adults could facilitate their OCIS and to narrow the health-related digital divide. These implications may also inform other developing countries.

Overall health information exposure, its barriers and impacts on attitude toward healthcare among cancer patients. The long-term aftermath of the 2011 triple disaster in Fukushima, Japan: A single institution cross-sectional study

Disasters can hinder access to health information among cancer patients. However, little is known regarding overall health information exposure (HIE), its barriers and its impacts on attitudes toward healthcare among cancer patients in the long-term aftermath of disasters. The aims of this study were threefold: assess the extent of HIE; identify associations between family composition and a non-engagement with HIE; and examine the effects of HIE on attitudes toward healthcare among local cancer patients-5 years after the 2011 triple disaster (earthquake, tsunami, and nuclear disaster) in Fukushima, Japan. We conducted self-administered surveys with all cancer and non-cancer surgery department outpatients at Minamisoma Municipal General Hospital (MMGH), Minamisoma City, from October 2016 to January 2017. In total, 404 patients (263 cancer patients and 141 non-cancer patients) voluntarily participated in the study. The results revealed that a regular level of HIE occurred among 90.5% of the cancer patients. In cancer patients, family composition was not significantly associated with HIE, and HIE was not associated with attitude toward healthcare. In conclusion, most cancer patients visiting the MMGH surgical department were regularly engaged in HIE.

Associations between social support and access to healthcare among Filipino women living in Japan

This study investigated associations between social support and access to healthcare among Filipino women living in Aichi Prefecture, Japan. A cross-sectional design was used. Self-administered questionnaires were distributed to Filipino women and collected 342 valid responses. Each participant was asked about her access to healthcare for her own health and for her youngest child's health, and social support, as well as her socio-demographic characteristics. Of these respondents, 114 women (33%) did not have a usual source of care for themselves. Participants in our study had higher Medical Outcome Study Social Support Survey scores than people living in other Southeast Asian countries. However, distribution of the score showed that there were outliers with low scores which were very different from the others. Women with the highest emotional/informational and tangible support score showed better access to healthcare (adjusted odds ratio=0.22, 95% confidence interval 0.10-0.50, and adjusted odds ratio=0.38, 95% confidence interval 0.17-0.85 respectively). Women with a Japanese husband also showed lower odds of no usual source of care (adjusted odds ratio=0.44, 95% confidence interval 0.20-0.95). On the other hand, there was no factors significantly associated with access to healthcare for their youngest child including social support. Emotional/informational and tangible support were crucial factors associated with access to healthcare among Filipino women in Aichi Prefecture.

Evaluating Local Multilingual Health Care Information Environments on the Internet: A Pilot Study

For foreign-born populations, difficulty in finding health care information in their primary language is a structural barrier to accessing timely health care. While such information may be available at a national level, it may not always be relevant or appropriate to the living situations of these people. Our objective was to explore the quality of online multilingual health information environments by pilot-testing a framework for assessing such information at the prefectural level in Japan. The framework consisted of five health care domains (health system, hospitals, emergency services, medical interpreters, and health insurance). Framework scores varied considerably among prefectures; many resources were machine-translated. These scores were significantly associated with foreign population proportion and the number of hospitals in each prefecture. Our multilingual health care information environment (MHCIE) framework provides a measure of health access inclusivity, which has not been quantified before. It is adaptable to other international contexts, but further validation is required.

Community Behavioral and Perceived Responses in the COVID-19 Outbreak in Afghanistan: A Cross-Sectional Study

OBJECTIVE

Community responses are important for the management of early-phase outbreaks of coronavirus disease 2019 (COVID-19). Perceived susceptibility and severity are considered key elements that motivate people to adopt nonpharmaceutical interventions. This study aimed to (i) explore perceived susceptibility and severity of the COVID-19 pandemic, (ii) examine the practice of nonpharmaceutical interventions, and (iii) assess the potential association of perceived COVID-19 susceptibility and severity with the practice of nonpharmaceutical interventions among people living in Afghanistan.

METHODS

A cross-sectional design was used, using online surveys disseminated from April to May 2020. Convenience sampling was used to recruit the participants of this study. The previously developed scales were used to assess the participants' demographic information, perceived risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and perceived severity of COVID-19. Multivariate analyses were conducted to assess the potential association of perceived COVID-19 susceptibility and severity with the practice of nonpharmaceutical interventions.

RESULTS

The Internet was the main source for obtaining COVID-19 information among participants in this study. While 45.8% of the participants believed it was "very unlikely" for them to get infected with COVID-19, 76.7% perceived COVID-19 as a severe disease. Similarly, 37.5% believed the chance of being cured if infected with COVID-19 is "unlikely/very unlikely." The majority of participants (95.6%) perceived their health to be in "good" and "very good" status. Overall, 74.2% mentioned that they stopped visiting public places, 49.7% started using gloves, and 70.4% started wearing a mask. Participants who believed they have a low probability of survival if infected with COVID-19 were more likely to wear masks and practice hand washing.

CONCLUSIONS

It appears that communities' psychological and behavioral responses were affected by the early phase of the COVID-19 pandemic in Afghanistan, especially among young Internet users. The findings gained from a timely behavioral assessment of the community might be useful to develop interventions and risk communication strategies in epidemics within and beyond COVID-19.

COVID-19: challenges faced by Nepalese migrants living in Japan

Background

Worldwide, COVID-19 has exacerbated the vulnerability of migrants, impacting many facets of their lives. Nepalese make up one of the largest groups of migrants residing in Japan. Crises, such as the ongoing COVID-19 pandemic could disproportionately affect migrants from low- and middle-income countries like Nepal, widening health and economic inequalities. An in-depth, comprehensive assessment is needed to appraise the diverse problems they encounter. Drawing upon qualitative interviews, this study aimed to identify challenges faced by Nepalese migrants in Japan as a consequence of the COVID-19 pandemic and to discuss their needs to counter these challenges.

Methods

This qualitative study employed an interpretivist approach to appraise the first-hand experience of Nepalese migrants living in Japan. Fourteen participants (8 males and 6 females, aged 21 to 47 years old) were recruited to participate in semi-structured in-depth telephone interviews (45–60 min) regarding: (a) their perceived current physical and mental health, (b) problems faced as a result of the COVID-19 pandemic, and (c) perception of available and necessary support structures. Purposive and snowball sampling techniques were used to recruit the participants. Interviews were recorded, transcribed, and thematically analyzed.

Results

Six themes were identified: 1) experiencing psychosomatic symptoms, 2) adoption of new healthy behaviors, 3) financial hardship, 4) family concerns, 5) reflections on discrimination and 6) reflections of existing support and expectations of support systems. The findings of our study illustrate the specific impact of COVID-19 among Nepalese migrants regarding their unstable employment conditions, perceived lack of social support, possible obligation to send money home, difficulty in accessing services due to the language barrier, and a lack of effective governmental support from Nepal. Pandemic-related adversity has negatively impacted migrants’ mental well-being, exacerbating their vulnerability.

Conclusions

Comprehensive and timely support should be provided to the vulnerable migrant population. Effective coordination among relevant parties in both countries, including the governments concerned, should be facilitated.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10796-8.