title: Leveraging public health nurses for disaster risk communication in Fukushima City: a qualitative analysis of nurses' written records of parenting counseling and peer discussions.
abstract: BACKGROUND
  Local public health nurses (PHNs) have been recognized as the main health service providers in communities in Japan. The Fukushima nuclear disaster in 2011 has, however, created a major challenge for them in responding to mothers' concerns. This was in part due to difficulties in assessing, understanding and communicating health risks on low-dose radiation exposure. In order to guide the development of risk communication plans, this study sought to investigate mothers' primary concerns and possible solutions perceived by a core healthcare profession like the PHNs.
  
  
  METHODS
  A total of 150 records from parenting counseling sessions conducted between PHNs and mothers who have attended mandatory 18-month health checkups for their children at the Fukushima City Health and Welfare Center in 2010, 2011 (year of disaster) and 2012 were examined. Discussion notes of three peer discussions among PHNs organized in response to the nuclear disaster in 2012 and 2013 were also analyzed. All transcribed data were first subjected to text mining to list the words according to their frequencies and inter-relationships. The Steps Coding and Theorization method was then undertaken as a framework for qualitative analysis.
  
  
  RESULTS
  PHNs noted mothers to have considerable needs for information on radiation risks as they impact on decisions related to relocations, concerns for child safety, and experiences with interpersonal conflicts within the family owing to differing risk perceptions. PHNs identified themselves as the information channels in the community, recommended the building of their risk communication capacities to support residents in making well-informed decisions, and advocated for self-measurement of radiation levels to increase residents' sense of control. PHNs also suggested a more standardized form of information dissemination and an expansion of community-based counseling services.
  
  
  CONCLUSIONS
  Inadequate risk communication on radiation in the Fukushima nuclear incident has resulted in multiple repercussions for mothers in the community. Empowerment of local residents to assume more active roles in the understanding of their environment, increasing PHNs' capacity in communication, and an expansion of health services such as counseling will together better address risk communication challenges in post-disaster recovery efforts.
authors.affiliation: Department of Public Health, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima-City, Fukushima 960-1295, Japan. agoto@fmu.ac.jp.
authors.forename: Aya
authors.initials: A
authors.lastname: Goto
authors.forename: Rima E
authors.initials: RE
authors.lastname: Rudd
authors.forename: Alden Y
authors.initials: AY
authors.lastname: Lai
authors.forename: Kazuki
authors.initials: K
authors.lastname: Yoshida
authors.forename: Yuu
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Donald D
authors.initials: DD
authors.lastname: Halstead
authors.forename: Hiromi
authors.initials: H
authors.lastname: Yoshida-Komiya
authors.forename: Michael R
authors.initials: MR
authors.lastname: Reich
mesh_terms: D003142:Communication; D003376:Counseling / Q000379:methods; D004190:Disasters; D005260:Female; D062406:Fukushima Nuclear Accident; D057220:Health Literacy; D006801:Humans; D007564:Japan; D010290:Parents; D010379:Peer Group; D011637:Public Health Nursing / Q000458:organization & administration / Q000706:statistics & numerical data; D011996:Records