IAEA - Hiroshima University Consultancy Meeting
Science, Technology and Society Perspectives on Nuclear Science,Radiation and Human Health – The International Perspective

Health literacy promotion in Fukushima
after the nuclear accident:
A case of responding to health care professionals’ needs
through the development of a health literacy toolkit
Aya Goto
Center for Integrated Science and Humanities
Fukushima Medical University

SLIDE 1

Fukushima nuclear accident
IAEA

Fukushima City
15% decline inunder 5-yo pop.
in 2 years
Depression and decline inmaternal confidence among
Fukushima mothers
BMC Psychiatry. 2015; 15: 59.
J Commun Healthc. 2014; 7: 106-116.

50 miles: US Recommended Evacuation Zone
SLIDE 2

Fear of unknown healtheffects of radiation
contamination due toconfusing and often
contradicting health risk
messages with difficult
scientific data
Picture: Leaflets about radiation
placed in the lobby of a healthcenter in Fukushima City.

SLIDE 3

Community health workers
Government

Fukushima Nuclear Accident Independent
Investigation Commission“Information for residents to make informed decisions”
How do we respond toparents’ concerns？
Public health nurses(gate keepers of community health)Nursery school teachers(key players of maternal and child health)

SLIDE 4

Responses in Fukushima City
Meeting time

(Ms after disaster)

May 2011(2 months)
July 2011(4 months)
November 2011
(8 months)

Major recommendations
Aim: To respond to parents’ immediate anxiety.
Information provision
Indoor play spaces
Aim: To respond to parents’ persistent anxiety.
Systematic screening of high-risk families
Individual and group counseling
Aim: To setup a long-term responding system.
Early parenting support system
Regular training sessions of public health nurses
Disasters. 2014; 38: s179–s189.
SLIDE 5Training workshops on radiation for nurses
Public health nurses
attending workshops
to learn about healtheffects of radiation
They voiced…
 Role as an information channel in the community Needed communication skills development;“We must say what we think about what we have learned;
not just what the government says.”
BMC Health Services Research. 2014; 14: 129.
SLIDE 6

From findings to actions
Community workers bridge science and community

Training on
Health Literacy
SLIDE 7

Health literacy
“The cognitive and social skills which
determine the motivation and ability ofindividuals to gain access to understand anduse information in ways which promote andmaintain good health” WHO, 1998

http://www.hsph.harvard.edu/healthliteracy/overview/
SLIDE 8Health literacy training

 Goto A, et al. Japan Medical Association Journal. 2014; 57: 146-53.
 Rudd RE. Assessing health materials: Eliminating barriers – increasing
access. 2010. http://www.hsph.harvard.edu/healthliteracy/
SLIDE 9Training content
Sentences: Grade level, topic sentenceNumbers: Numeracy level
RISK is one of the most difficult statistical concepts.
(Apter AJ, et al. J Gen Intern Med. 2008;23(12):2117-24.)

Graphs: Pictogram
Communication: Marker method(Method to ask readers to mark difficult words and phrases.)

SLIDE 10

Training evaluation
Workshop evaluation surveys among participants
65 nurses and 45 teachers who attended workshops
in 2013-2014
At the end of each session, 1 month (nurses only) and1 year after the second session.
Evaluation items
Application, confidence gain and interest in furthertraining.
12 specific training goals: 4 items each on knowledge,
material assessment and development
 Opinions on applications and barriers of learned skills indaily practices

Japan Medical Association Journal. 2015; 58: 1-9.
Journal of Seizon and Life Sciences. 2017; 27: 192-207.
SLIDE 11

Analysis
Quantitative data: Descriptive analysis by using
STATA version 13.
Qualitative data: Text mining by using KH coder.

KH coder breaks sentences into pieces, lists frequent words and builds a diagram toshow their relationships. We listed and focused on words used more than twice andcategorized into major topics by referring to the diagram and context in originalsentences.
SLIDE 12Achievements toward training objectives
I applied learned skills in practice.
I gained confidence in assessing inrevising written materials.
I want to attend further training.
Selected knowledge items
I can explain health literacy needs.
I can explain numeracy levels.
Selected assessment items
I can use the Marker Method
Selected development items
I can write easy-to-read text.
I can explain risk.
SLIDE 13

TOTAL
(N=57)
61%

Nurses Teachers(N=31) (N=26)
68%
47%

27%

32%

45%

68%

81%

54%

42%
9%

65%
12%

15%
4%47%

61%

29%

44%
14%

52%
16%

35%
12%

Application and confidence
Nurses and teachers
I gained confidence in assessing
and revising written materials
I want to attend further training.

Non-users Users(N=22) (N=35) P value
32%
45%
0.02
41%

86%

<0.001

A five-ping Likert-scale ranging from highly disagree (1) to highly agree(5) was used. Those who answered 4 and 5 to the item “I applied learned
skills in practice” was classified as users. Chi-square test was used.

SLIDE 14

Applications during the follow-up
Proportion of sentences that include words
in each category is shown. Number ofsentences (denominator) was 28 for both.

“Even among staff, we started circulating documents
and getting signatures in addition to oralcommunication.” (Nursery school teacher)
SLIDE 15

GoalsHealth literacy
andhealth system

Healthliteracy
Community

Team work
European Health Psychologist.
2015; 17: 281-285.
SLIDE 16

Difficulties during the follow-up
Number of sentences(denominator) was 22
for nurses and 12 forteachers.

“How can we explain professional terms in a waythat is understandable to villagers?”(Public health nurse)
SLIDE 17

From findings to actions
We therefore upgraded the workshop by
developing a pocket-size “health literacytoolkit” that contained…
1. a glossary explaining radiation-related
terms in plain language and2. an index to measure the accessibility ofboth text and numerical information.

SLIDE 18

Development processes of the toolkit

SLIDE 19

SLIDE 20

SLIDE 21

Sample radiation-related term in the glossary
Words
Definition and explanation
Threshold The value under which effect is uncertain.
From lower to higher value: The point where effectappears.
From higher to lower value: The point where effectbecomes unclear.
https://www.cdc.gov/ccindex/tool/index.html

SLIDE 22

Future direction
The major limitation of the present work isthat it still lacks an assessment of effects oftraining on accessibility of information from acommunity perspective.
We will incorporate the formative
assessment and revision of the toolkit into
the workshop activities.

SLIDE 23

Acknowledgement
This project was supported in part by the research grants ofFukushima Labor and Health Center, Institute of Seizon andLife Sciences, and JSPS KAKENHI (No. 16K09135).
The workshop was conducted as part of the Fukushima
prefectural training program for public health nurses.
Project team includes Rima E Rudd (Harvard University)
and Alden Y Lai (Johns Hopkins University) who haveprovided continuous invaluable contribution bringing ininternational perspectives.

SLIDE 24