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The association between help seeking behaviors to mild symptoms and quality of life among rural older people in Japan

太田, 龍一 筑波大学 DOI:10.15068/0002005620

2022.11.24

概要

Background
Help-seeking behaviors (HSBs), which can be associated with health conditions and require lay and professional care, can be affected by medical resources and community conditions. In rural contexts, few medical resources and aging populations can significantly affect the usage of lay and professional care, especially regarding mild symptoms. Therefore, the role of lay and professional care for mild symptoms should be considered among rural older populations.
　The association between HSBs, mild symptoms, and health conditions among rural older populations should be investigated to improve the quality of lay and professional care. Despite multiple studies regarding HSBs, there is a lack of research regarding the association focusing on lay and professional care in rural contexts. Health conditions can be explained through subjective health, which can be measured through self-rated health (SRH) and quality of life (QOL).
　To clarify this association, three studies were performed. Initially, a list of HSBs was developed to investigate the behaviors that rural older populations adopt for managing mild symptoms, categorizing them into lay and professional care (Study 1). Using this list, the association of lay and professional care with mild symptoms and SRH was investigated (Study 2). Furthermore, by focusing on modifiable lay care, the association between preference for self-management and QOL among rural older populations was examined (Study 3).

Study 1: The development of a list of HSBs in relation to mild symptoms
Methods
A mixed-method study was performed on patients aged 65 years and older who regularly visited the Kakeya and Tai clinics and Unnan City Hospital in Unnan City, located in the Shimane Prefecture. The following steps were performed to prepare a list of HSBs and verify its validity and reliability:
1. A symptom diary was distributed to participants, who were asked to describe their subjective symptoms and HSBs every day for one month (phase 1).
2. Purposeful sampling was used, and semi-structured interviews were conducted with 39 people regarding their intended HSBs for mild symptoms. The interview statements recorded were classified into lay and professional care using content analysis (phase 1).
3. Based on the results of phase 1, a questionnaire that measures an individual’s HSBs was developed.
4. A self-administered questionnaire derived from the developed questionnaire was distributed to participants. The results of the symptom diary were subsequently classified into lay and professional care. The validity of the questionnaire was confirmed based on the results (phase 2).
5. A similar questionnaire was re-administered one month later to confirm its test-retest reliability (phase 2).

Results
A total of 267 participants were evaluated in phase 1. Their average age was 75.1 years; 50.1% were

men, and 49.9% were women. A questionnaire evaluating the preference for lay vs. professional care in relation to mild symptoms was developed based on the results of the semi-structured interviews and contents of participants’ symptom diary. A total of 315 participants were included in phase 2—their average age was 77.7 years; 46.0% were men, and 54.0% were women. The Spearman’s rank correlation coefficient was used to test the validity of the questionnaire, which showed a value of 0.704 (p < 0.001). The test-retest reliability for mild symptoms showed kappa values of 0.836 for lay care and 0.808 for professional care.

Study 2: The association between preferences for lay care vs. professional care and better SRH of rural older patients
Methods
The study was performed on 169 patients aged 65 years and older who regularly visited the Kakeya and Tai clinics in Unnan City, located in the Shimane Prefecture. The dependent variable was SRH. The independent variables were age, sex, smoking status, drinking status, work history, educational history, social support, socioeconomic status, life history, social capital, Charlson Comorbidity Index score, and HSB. Logistic regression analysis was used to calculate the odds ratio (OR) of HSBs concerning SRH.

Results
A total of 169 participants had an average age of 77.5 years (SD = 8.3). Employment (OR = 2.59, p = 0.03), regular exercise habits (OR = 2.42, p = 0.04), good socioeconomic status (OR = 6.67, p = 0.001), independence (OR = 0.23, p = 0.015), and preference for both lay and professional care (OR = 2.39, p
= 0.046) were significantly associated with SRH. Among the HSBs, self-management was associated with higher SRH (adjusted odds ratio [AOR] = 4.10, p = 0.002).

Study 3: The association between self-management of mild symptoms, health state and QOL
Methods
Study 3 included all participants aged 65 years and older, living in the Kakeya, Tane, Tai, and Matsukasa districts of Unnan City. The primary outcome was QOL. The independent variables were age, sex, smoking status, drinking status, work history, education history, social support, socioeconomic status, life history, social capital, and self-management of mild symptoms. QOL was measured as health status index scores by using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire.
　Participants were divided into two groups—those who practiced self-management (the exposure group) and those who did not (the control group)—based on their responses to the questionnaire regarding care preference. Propensity score matching was performed to adjust for the differences in background factors between the exposed and control groups, divided by the presence or absence of self- management for mild symptoms. After the adjustment, the participants’ health status index scores and levels of health state by the five dimensions in the EQ-5D-5L questionnaire were compared between the exposed and control groups.

Results
A total of 834 participants were included in Study 3, of whom 596 had their propensity scores matched; participants’ mean ages were 77.9 years (exposure group) and 78.4 years (control group). The health status index scores of EQ-5D-5L were significantly higher in the exposed group than in the control group. Further, the levels of health state in the exposed group were significantly higher in the dimensions of movement, normal activity, and anxiety/depression than those of the control group.

Conclusion
I established a list of HSBs to measure the preference for lay care vs. professional care regarding mild symptoms. I also found that the preference for both lay and professional care was associated with higher SRH among older patients, and that for self-management was associated with those who had better subjective health. However, evidence regarding the interventions required for HSBs according to different health conditions is still lacking. By clarifying the relationship between self-management and subjective health conditions through longitudinal studies, the interventions for HSBs may improve rural older people’s health conditions.

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