BackgroundVaccination is an important element of health maintenance in family medicine. The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is highly recommended for the elderly, but its uptake is low in Japan. Primary care system remains under development and preventive services tend to be neglected in the Japanese medical practice. The study aims to investigate the association between family physician’s recommendations for PPSV23 during outpatient care and PPSV23 vaccination intention and behavior in the elderly.MethodWe conducted a cross-sectional study with a questionnaire at a family medicine clinic in a rural area in Japan. The participants were over the age of 65 without dementia who had maintained a continuity with the clinic. The questionnaire inquired PPSV23 vaccination status, family physician’s advice for PPSV23, socio-demographics, and the constructs in the Health Belief Model. We defined those who had had vaccination intention and behavior as “PPSV23 vaccinated group” and those who had no vaccination and uncertainty about being or no intention to be vaccinated in the future as “PPSV23 unvaccinated group.” We used chi-square test for correlation between physician advice and PPSV23 vaccination/intention, univariate and multivariate logistic regression analysis for factors related to the vaccination/intention, and descriptive analysis for reasons for reluctance to the vaccination.ResultsWe analyzed 209 valid responses. There were 142 participants in the PPSV23 vaccinated group and 67 in the PPSV23 unvaccinated group. The PPSV23 vaccination group was more likely to have had their physician’s advice (80.2% vs 21.3%, p < 0.001). Multivariate logistic regression analysis showed a significant association between PPSV23 vaccination and their physician’s recommendation (OR 8.50, 95%CI 2.8–26.0), awareness of PPSV23 (OR 8.52, 95%CI 2.1–35.0), and the perceived effectiveness of PPSV23 (OR 4.10, 95%CI 1.2–13.9). The reasons for reluctance to get vaccinated included lack of understanding of PPSV23, lack of physician’s recommendations, and concerns about side effects of PPSV23.ConclusionFamily physician’s recommendation was positively correlated with PPSV23 vaccination intention and behavior in the elderly. This reinforces the importance of providing preventive services during time-constrained outpatient care, even in medical systems where it is undervalued.Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0841-3) contains supplementary material, which is available to authorized users.

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53 375-389 2008 375 Takahiro Goto: The life structure of a rural district and comprehensive sport club:focusing on the relation between life structure and sport practice. Japan. J. Phys. Educ. Hlth. Sport Sci. 53: 375-389, Decemer, 2008.Abstract : Comprehensive sports clubs are designed for residents of urban communities comprising socially independent, unrelated individuals. Therefore, such clubs would not be viable in rural districts where strong relationships among residents still exist. The purpose of this research was to consider the kind of comprehensive sports club that might be viable in the context of a rural community, by analyzing the relationship between the lifestyle and sports practices of the local residents. Taking Oguni Town as a concrete example, the social structure of the district was analyzed along with the relationships between life structure and sports practices. For the former analysis, interviews with representatives of the local residents (Nϭ3) were used, and for the latter a questionnaire survey (Nϭ252) was employed. Analysis of the social structure of the district revealed a tendency for privacy and fluidity, similar to the situation in an urban area. Conversely, the basic lifestyle of a 'village' -or, its rootedness-preserved the life structure of the community. Characteristics of the 'village' included a tendency to form local groups through the activities of intermediate groups.From this analysis of the relationship between life structure and sports practice, it can be concluded that the life structure of a rural district with strong rootedness has a great influence on the quality of sports practices, i.e. the preservation of group events. These results suggest that a comprehensive sports club in a rural district should not be a functional group focused on individuals but rather adapted to the lifestyle of the 'village' community. It should also serve the function of building a network between intermediate groups.

This study was designed to clarify how a "comprehensive community sports club" (referred to as sports club hereafter) was established by explanation and persuasion through conversations during the fostering phases. Fieldwork and the collection of conversation data was performed at 14 meetings held during the period from April 9, 2003 to November 6, 2003, in "A" district of Kiryu city in Gunma prefecture. The fieldnotes used can be described as sketches with simultaneous notes inserted. The conversation data collected were transformed into open coding and focused coding, and then analytic categories were selected. As a result, a core category, "justification for the sports club", and five constituent categories, "preferential use of a public institution", "superiority over existing sport club", "making full use of community centers", "application of members' social positions", and "conventions of the local inhabitants" were formed. The members who participated in the meetings attempted to justify the establishment of the sports club in this district by discussing and utilizing the above categories.

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