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This editorial explores the transformative impact of digital health technologies in rural areas, focusing on their role in bridging healthcare gaps and empowering communities. Drawing from research in Unnan City, the article highlights how social network-based platforms, such as the LINE app (LY Corporation, Tokyo, Japan), have enabled residents to seek medical advice and share health concerns anonymously. The discussion covers both the positive impacts and challenges, including misinformation and the digital divide, while emphasizing the need for thoughtful implementation and continuous education. The editorial calls for collaborative efforts to enhance the reliability and accessibility of digital health solutions, ensuring equitable healthcare access for all.

Family medicine is a vital medical specialty in an aging society. The scope of each family doctor's training and practice varies according to the context of their work, their roles, the organization and resources of the health systems in each country, and their ability to adapt to the healthcare needs of their country. As societal requirements change, so does the role of family medicine. In Japan, family physicians' educational systems were officially established in 2017 as the nineteenth specialty, following discussions among family physicians, general internal medicine physicians, and hospitalists. Family physicians' specialization in systems could facilitate access to appropriate health resources with proper timing while respecting the culture and context of each patient. Therefore, family physicians can be systems specialists on the same basis as organ and other specialists. Family physicians include people and families in their ecological systems. Family physicians should therefore specialize in healthcare systems.Family medicine is a vital medical specialty in an aging society. The scope of each family doctor's training and practice varies according to the context of their work, their roles, the organization and resources of the health systems in each country, and their ability to adapt to the healthcare needs of their country. As societal requirements change, so does the role of family medicine. In Japan, family physicians' educational systems were officially established in 2017 as the nineteenth specialty, following discussions among family physicians, general internal medicine physicians, and hospitalists. Family physicians' specialization in systems could facilitate access to appropriate health resources with proper timing while respecting the culture and context of each patient. Therefore, family physicians can be systems specialists on the same basis as organ and other specialists. Family physicians include people and families in their ecological systems. Family physicians should therefore specialize in healthcare systems.

Help-seeking behavior (HSB) is vital for older people to sustain their health. As people in aging societies increasingly demand management of their multiple symptoms, communities should encourage HSBs. In rural communities, insufficient healthcare and human resources influence older people’s health. However, no related comprehensive evidence exists so far. This study investigates the present condition of older people’s HSBs in rural contexts in aging societies. We conducted a systematic review by searching six databases (PubMed, Cochrane Library, EMBASE, Medline, and Web of Science) for original studies regarding HSBs of older people in rural contexts published until January 2022. Extracted articles were analyzed based on participants, settings, HSB causes and contents, and older people’s HSB outcomes in rural contexts. Sixteen studies were included in the systematic review: seven investigated the associations between HSBs and participants’ backgrounds, and three the quality of life. Six studies investigated HSB perception, diagnosis, clarifying HSB contents, professional care trend, self-rated health, and mortality. Unlike few studies investigating the association between HSBs and health-related outcomes, this systematic review explains the current evidence regarding rural older people’s HSBs. Due to insufficient evidence from longitudinal studies in clarifying interventions for effective HSBs, future studies should use observational and interventional designs.

Community organizing with government support, termed local self-governance (LSG), is a form of policy decentralization for community wellbeing through solutions tailored to local issues. One form of LSG is multifunctional autonomy, in which citizens can comprehensively manage their communities with government support. This study clarified the effect of multifunctional autonomy on healthy life expectancy by assessing related advantages and challenges in rural Japanese communities, using a mixed-methods approach. Disability-free life expectancy from 65 years (DFLE-65) was assessed to compare healthy life expectancies between two rural Japanese cities (with/without multifunctional autonomy). Comparisons revealed better DFLE-65 only among older men in a city with multifunctional autonomy. A cost-effectiveness analysis investigated the relationship between the budget and DFLE-65 change using questionnaire data. Cost-effectiveness analysis of multifunctional autonomy indicated 61,147 yen/DFLE-65. Thematic analysis revealed that multifunctional autonomy created new roles for older men, improving community relationships. However, sustainable multifunctional autonomy in LSG communities may be hindered by a generally aging society, generation gap, and lack of mutual understanding between rural communities and local governments. To ensure the sustainability of multifunctional autonomy, collaborations between local communities and governments and among various generations are critical.

Reflection in medical education is vital for students’ development as professionals. The lack of medical educators in rural family medicine can impinge on the effective reflection of residents’ learning. Hence, based on qualitative research, we proposed a framework regarding reflection in rural family medicine education, indicating when, where, and how reflection is performed and progresses. The contents of reflection include clinical issues regarding knowledge and skills, professionalism in clinical decisions, and work-life balance. The settings of reflection include conference rooms, clinical wards, residents’ desks, and hospital hallways. The timing of educational reflection includes during and after patient examination and discussion with various professionals, before finishing work, and during “doorknob” times (right before going back home). Rural medical teachers need competence as clinicians and medical educators to promote learning in medical residents and sustain rural medical care. Furthermore, medical teachers must communicate and collaborate with medical residents and nurses for educational reflection to take place in rural family medicine education, especially regarding professionalism. In rural family medicine education, reflection can be performed in various clinical situations through collaboration with learners and various medical professionals, aiding the enrichment of residents’ learning and sustainability of rural medical care.

Older people’s help-seeking behaviors (HSBs) may be limited because of various factors and are essential in improving healthcare in aging societies. This cross-sectional study investigated the association between perception of HSBs, concrete HSBs, quality of life (QOL), and other variables among people over 65 in rural Japan using standardized questionnaires. Participants were divided into high or low health status index score groups based on a median split. Logistic regression was used to assess the association between perception of HSBs and high QOL while controlling for age, sex, living conditions, annual health checks, having chronic diseases, regular clinic visits, smoking, habitual alcohol consumption, education, living conditions, social support, social capital, socioeconomic status (SES), and health literacy. Participants in the high QOL group were younger (p < 0.001), and had fewer chronic diseases and regular clinic visits than those in the low QOL group (p < 0.001). The multivariate logistic regression model revealed that age, chronic diseases, tobacco usage, family consultation, and consulting primary care physicians negatively predicted QOL. High SES, social capital and support, and HSB intention positively predicted QOL. Self-efficacy and intention regarding HSBs should be investigated to improve health among older rural people.

Bedside teaching is essential in family medicine education so that residents may learn about various clinical conditions and develop professional skills. In particular, bedside teaching is useful in a rural context because rural family medicine deals with a broad scope of biopsychosocial problems among older patients. Accordingly, based on an inductive thematic analysis, we propose a framework for bedside teaching in rural family medicine education, which consists of four themes: accommodation of different learners, near-peer learning, the change in engagement of medical teachers in bedside teaching, and driving interpersonal collaboration. Bedside teaching can promote interactions between different medical learners. Near-peer learning in bedside teaching compensates for the limited availability of educators and improves learners’ motivation for self-directed learning. Through bedside teaching, medical learners can observe each other and provide constructive feedback, thereby improving their relationships and learning. For effective bedside teaching, medical educators should facilitate learners and collaborate with other medical professionals. Additionally, bedside teaching should accommodate a variety of learners, facilitate near-peer and self-directed learning, educators’ involvement based on cognitive apprenticeship, along with interprofessional collaboration with nurses. Interprofessional collaboration between rural family medicine teachers, learners, and nurses may improve the quality of patient care due to the increased understanding between patients and other medical staff in hospitals.

Residents-as-teachers (RaT) is a theoretical framework emphasizing the significance of the similar learning background of teachers and learners. In Japan, community-based medical education (CBME) is a practical approach to teaching family medicine. This study aimed to investigate the impact and challenges of RaT on the learning of medical students and residents in CBME at a rural community hospital in Japan. Over the course of a year, the researchers conducted one-on-one interviews with three residents and ten medical students participating in family medicine training at the hospital. The interviews were recorded and transcribed verbatim. Grounded theory was used in the data analysis to clarify the findings. Three key themes emerged from the research: lack of educational experience with RaT, effectiveness of RaT, and challenges of RaT. Although participants were prejudiced against RaT, they felt its implementation could facilitate the establishment of beneficial relationships between learners and teachers. They were also able to participate in medical teams effectively. The findings suggest that the increased participation of senior doctors in RaT could strengthen its learning effects. RaT in rural CBME should be applied in various contexts, and its effectiveness should be further investigated both qualitatively and quantitatively.

Background Health literacy facilitates an individual’s ability to interpret and utilize medical information, thereby influencing their quality of life. Despite the benefits, the current oversaturation of information necessitates the support of healthcare professionals. Help-seeking behavior (HSB) is a term that describes the actions taken to assuage health concerns, and timely medical consultations are critical, especially for older individuals in rural areas who often face barriers to accessing care. These challenges are exacerbated by the perceived psychological distance from medical services in rural settings due to past negative experiences; however, the emergence of social media has helped form a bridge, allowing for direct communication with physicians. While consultations with artificial intelligence (AI) do occur, interaction with human physicians remains the gold standard. Thus, this study sought to understand social media’s role in facilitating health consultations in rural areas and the implications for primary care education among physicians. Methods This qualitative study, conducted from September 2022 to June 2023, employed a grounded theory approach to analyze information about a social network-based consulting system that utilized the LINE application. Residents posted anonymous health-related concerns, and comments were extracted. Two researchers coded and assessed the data; another specialist reviewed the findings. Results A total of 621 citizens participated, generating 10,432 posts. The grounded theory approach identified five major themes regarding health-related social networking in rural settings: (1) mutual exploration for information sharing highlighted distrust toward primary care physicians; (2) temporary collaboration resulted in superficial health discussions and relationship-building through empathy; (3) conflicts arising from differing health perspectives and misinformation sharing led to intense debates; (4) anxiety was resolved through shared illness experiences and increased empathy, enhancing psychological safety; and (5) a mutual assistance community was created, characterized by improved health dialogues and HSB among participants. Conclusions The high engagement with the social network-based consulting system in rural Unnan City highlights technology’s pivotal role in facilitating health dialogue and community engagement, despite challenges related to misinformation and health literacy complexities. As a reflection of the community’s health perceptions and dynamics, future adaptations should incorporate strategies to combat these challenges while preserving collaboration and support.

Background Appropriate help-seeking behavior (HSB) that involves lay and professional care may moderate the usage of medical resources and promote good health, especially among the rural elderly. However, there is little evidence regarding the rural elderly’s HSB choices for mild symptoms. Therefore, this study attempts to bridge this gap. Methods The participants were patients living in rural areas and over the age of 65, who attended Japanese clinics and general hospitals. In Phase 1, monthly diaries and one-on-one interviews about their mild symptoms and HSB were used to establish HSB items and assess its content validity. Content analysis helped determine the items. In Phase 2, participants were asked to complete the list to measure HSB. The answers to the list and HSB mentioned in the diaries were compared to evaluate concurrent validity. Retests were conducted to examine the content’s reliability and test-retest reliability. Results Phase 1 included 267 participants (average age = 75.1 years, standard deviation [SD] = 4.3; 50.1% male). The diary collection rate was 97.6%. Of the participants, 70.4% used lay care and 25.4% used professional care. Content analysis identified eight types of lay care and four types of professional care. Phase 2 included 315 participants (average age = 77.7 years, SD = 8.27; 46.0% male). In terms of validity, the results of the list and the diaries were correlated (Spearman r 0.704; p  < 0.001). The most common behavior with mild symptoms was consulting with primary care physicians, followed by self-care and using home medicine. The test-retest reliability for mild symptoms found kappa values of 0.836 for lay care and 0.808 for professional care. Conclusions The choices of HSB for mild symptoms clarified identified in this study have high validity and reliability. Therefore, it can be used to assess the relationships between HSB and health conditions and the effectiveness of health promotion on rural older people’s HSB.