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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.

Background Help-seeking behaviors (HSBs) are essential for disease prevention and health promotion. Dialogues with peers and medical professionals can improve HSBs, both qualitatively and quantitatively. Rural communities lacking healthcare resources require effective HSBs for healthcare sustainability. The current study aimed to investigate the effect of health dialogues between medical professionals and rural citizens on their HSBs. Methods All procedures complied with the Declaration of Helsinki and its subsequent amendments. The Unnan City Hospital Clinical Ethics Committee approved the study protocol (No. 20,220,002). A grounded theory approach was employed for the health dialogue participants in rural communities. Health dialogues with family physicians were conducted once a month at rural community centers. The dialogues and focus group interviews were recorded and coded to investigate changes in participants’ perceptions and behaviors regarding HSBs. Results Twenty-one dialogues were conducted in two rural community centers, with a total of 112 participants. The average age of the participants was 70.2 years (standard deviation = 5.4), with 24% being males. Analysis of the grounded theory approach revealed four themes, namely joy-driven dialogue driving the realization of HSBs, reflection on personal HSBs through learning from others, revising HSBs based on rural social resources, and familiarity with physicians, hence motivating safe and secure HSBs. Conclusions Mitigation of barriers between citizens and medical professionals and improvement of psychological safety in communities can drive effective HSBs in rural communities.

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.

Background The rural-urban disparity in healthcare quality is a global issue. Compared with living in urban areas, living in rural areas is associated with poorer healthcare outcomes. Moreover, the shortage of healthcare providers in rural areas is a worldwide concern. This scoping review aims to map existing evidence regarding rural-urban disparities in access and quality of healthcare in Japan using the Donabedian model as a theoretical framework and to identify conceptual and measurement gaps. Methods This review targeted published articles and gray literature. We included documents that (1) were based on Japanese populations and (2) compared the quality of care between defined rural and urban areas. We excluded articles if they (1) were published during or before 2005 since the Japanese government amended the Medical Care Law in 2006; (2) focused exclusively on urban or rural areas; or (3) were not published in English or Japanese. This study employed PubMed, EMBASE, Web of Science, the Japanese medical literature database, ICHUSHI, and CiNii Research. We extracted quality indicators (structure, process, and outcomes) based on the Donabedian model. We recorded the definitions or indicators of rurality described by the studies. Results Out of 5,020 articles, 15 were included. Only one study was conducted in a primary care setting. Moreover, no study evaluated the “outcomes” of the Donabedian model in a primary care setting. Regarding the definitions or indices of rurality, the most commonly used indicator of rurality was population size, followed by population density. The cutoff values or descriptions of rurality using these indicators differed across studies. Conclusion This study mapped rural-urban disparities in access and quality of healthcare in Japan. These findings highlight the need to evaluate rural-urban disparities in the “outcomes” of care in primary care settings in Japan and the lack of common indicators of rurality.

Elderly-onset rheumatoid arthritis (EORA) is prevalent among older patients, and its incidence is increasing due to aging societies. However, differentiating between EORA and polymyalgia rheumatica (PMR) is challenging for clinicians and hinders the initiation of effective treatment for rheumatoid arthritis among older generations, thereby allowing its progression. Therefore, we conducted a qualitative synthesis of narrative reviews via meta-ethnography regarding seronegative EORA diagnosis to clarify the methods to differentiate seronegative EORA from PMR. Three databases (PubMed, EMBASE, and Web of Science) were searched for relevant reviews published between January 2011 and October 2022. The extracted articles were synthesized using meta-ethnography, and 185 studies were selected following the protocol. Seven reviews were analyzed, and four themes and nine concepts were identified. The four themes included difficulty in differentiation, mandatory follow-up, and factors favoring rheumatoid arthritis and those favoring PMR. Factors favoring seronegative EORA and PMR should be considered for effective diagnosis and prompt initiation of disease-modifying anti-rheumatic drugs. Mandatory and long follow-ups of suspected patients are essential for differentiating the two diseases. The attitude of rheumatologists toward tentatively diagnosing seronegative EORA and flexibly modifying their hypotheses based on new or altered symptoms can aid in effective management and avoiding misdiagnosis.

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.

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.