STS approach with Kurumaza dialogue
for residents including mediators.
Fukushima Medical University
Atsushi Kumagai

23 May, 2017

1. to support citizens in understanding
about the risk level.
1. Sharing the accurate information
2. Suggestion from the expert

2. to support citizens to make their owndecision.

How often radiation anxiety
cause problems in your life?
(in this 1 month?)
Often

6%
None

57%

Sometime

15%
infrequent22%

Feb-Oct 2015
The Fukushima Health Management Survey
The Mental Health and Lifestyle Survey

Around 40 % people
have real problem intheir life.

Obesity

Refuge Life

Hypertension

Hyperlipidemia

GlucoseIntolerance

LiverDysfunction

Most of people don’t knowwhat the real health problem is.

5• We started health consultation May, 2012
with local governments (public health nurse)of evacuation areas.

• Target: Residents• We accept all kind of health consultation.
• 4,889 cases (FY2012-2015).

Reason people hesitate
to open up their mind

Reasons people cannot
return to their original
town•Individual conflict–due to difference ofperception–due to monetarycompensation.

•Collapsed socialfoundation•Lost social relationship(community)•Wild animals

• Basically, Japanese individuals hesitate toexpress their sensitive anxieties.
• Residents observe “new supporter (≒outsider)”is reliable or not, during consultation.
• They could not express their taboo to unreliable“new supporter”

9• We can response topersonal situation.
Personal Consultation• But, we sometimes could
not go to the core ofissue because ofresident’s personality, ourpoor communication skill
and vague distrust inlimited time.
10• Group discussion canbuild a sense of ease.
Round Table Dialogue• Same background group
have common problems.
• It is difficult to saysomething in front ofpeople by shy characters.
11• Every 2 months.
– Managing with local public health nurses– Group work: 5-10 mothers
1. Free time to write down the question,
anxiety and opinion to the cards(anonymous approach)
2. Group work: categorizing issues together
3. Small lecture and discussion about theirproblems
4. Next theme12• Some of young mothers didn’t attend to“radiation lecture” at the initial phase.
• But, they couldn’t receive accurate information
when they become pregnant.
• It is hard to express their real anxieties because of
shy character and peer pressure in thereconstruction momentum.
• But, they can share through opinion anonymous
card session.
13• Their comments include all kind of local problem.
– Safety of radiation, disagreement among friends,problems of mother in law, etc.

• They can understand easily because it is selfexpressed issue.
• Expert should do listen everything and sort theirproblems and discuss about each issue.
• Participants observe the expert’s attitude,carefully. Therefore, many of them can express
their true opinion at the end of session withoutcard.
• It is regular and opened dialogue project.

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1. Obtain the food at local market with radiation
consultant.
2. Cook and eat together.
3. Check the cesium level of the cooked dishes.
4. Whole body counter.
5. At the same time, they start the monitoring of
external dose (2 week).
6. One month later, I explain them the results ofsurveys.
7. They can understand their own data easily.
Local People Participatory Approach15• Targets are residents of local community.
• They are not good at “difficult” story of radiation
basics. Actually, many of them get tired of hearing the“difficult” lectures.
• They want to know what the real threat is, in theirusual life. “Our veggies are safe or not.”• We prepared– Participatory analysis of food, internal contamination andexternal dose.

• But, they change to ask us wide range of question at
the end of the session. I responded all kind of healthconsultation.
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Daily Life and Real Problems
in Refuge/ Local Life
Trusted Local key person
Public Health Nurse

Radiation issues

Experts from University

Sense of belonging to the community is important.
But, dialogue and discussion without medical
viewpoint is not effective.
Because “radiation issue” is one of core issues.

• Principle of “Trust” is“To share significant values and goals” .
(Salient Value Similarity Model)………………………………………………………………………
• Basis of radiation anxiety is health anxiety.
• Goal of medical professional is“Resident’s overall health”.
• Medical /health professionals are the best suitedfor the communicator of mixed anxieties.

• Knowledge of radiation basics,• Understanding of dose related health effects,• Understanding the concept of risks,• Understanding for some kind of difficulties during
the communication,• Understanding of the specificity of “radiation riskcommunication” including social and psychosocial aspects,• Skills of confidence-building,• Skills of problem resolution in various situation.
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Obesity

Refuge Life

Hypertension

Hyperlipidemia

GlucoseIntolerance

Liver
Dysfunction

Not only“To convey the information”,“To leave a decision up to them”,
But also“To improve the public health finally”.
Medical professionals should stimulate“Own awareness” and “voluntary initiative”.
But it is based on the confidentialrelationship.

Especially,• We have been supporting the voluntarycommunication by round table with local
mediators in addition to personal consultation.
• They can understand the local socialized issues.
• Dialogue conducted by expert should be changed
to local initiative.
• It is quite important to cultivate the local
communicators (facilitators).
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