"Healthy Akame!" a Community-Government-University collaboration in community-based participatory research (CBPR) with mixed-method to address health issue in rural Japan community

Background: Public health programs are commonly designed as one-fit for all, to solve problems with high prevalence or cost. However, differences in community’s values and interest might create gaps between health program’s objectives and its implementation. We hypothesized that implementation of community-based participatory research (CBPR) which involve community in every step, can promote more effective program and empower community. This first step of CBPR aimed to assess community needs and develop tailored program for community in rural Japan. Methods: This study applied sequential exploratory mixed-method study (qualitative followed by quantitative). First, we formed community advisory board (CAB) that represented community organization, city officials, and university researchers. CAB conducted group discussions with community residents to identify community’s health issues and strength. Records of group discussions were analyzed with thematic analysis and developed into questionnaire. Questionnaire was sent to all households in community to get priority score of health issues and proposed action, also to assess the willingness to participate in community health program. CAB designed program based on overall results. Results: Ten group discussions with 68 participants generated the following health issues: 1) Diseases, 2) Unhealthy behavior, and 3) Unsupportive environment. Nature, vacant lot, and local farms were considered as local strength. From 1470 households, 773 questionnaires were collected. Cancer, lifestyle-related diseases, and cerebrovascular diseases were ranked highest as health problems. Improving services and access for medical checkup were considered most important. Utilization of public space, local farm, and collaboration with community health office came next for proposed action. Female, people who practice preventive behavior and have high commitment to community were more likely to attend community health program. Almost half participants were unwilling to attend, with majority were work-related reasons. Taking consideration of feasibility and target coverage, CAB decided to develop community program to tackle lifestyle-related diseases. To make advantage of local resources, the main activities centered on health education classes, cooking classes, healthy cafeteria, local farmers market, exercise classes and sports events. Conclusions: CBPR approach was useful to identify community’s needs and to develop a community-based health program that address the needs by utilizing local strength.