title: What sort of medical care is ideal? Differences in thoughts on medical care among residents of urban and rural/remote Japanese communities.
abstract: Studies of aspirational ideals of medical care generally focus on patients rather than on ordinary people receiving or not receiving medications at the time of interview. The literature has not accurately conveyed the distinct ideals in individual communities or undertaken inter-regional comparisons. This current qualitative study focused on ideal medical care as perceived by residents of distinct Japanese communities in their everyday lives. Between December 2011 and November 2012, one-on-one and group-based semi-structured interviews were conducted with 105 individuals, each of whom had continuously lived for 20 years or more in one of the four types of communities classified as either 'metropolitan area', 'provincial city', 'mountain/fishing village' or 'remote island' in Japan. Interviews were transcribed from digital audio recordings and then analysed (in tandem with non-verbal data including participants' appearances, attitudes and interview atmospheres) using constructivist grounded theory, in which we could get the voice and mind of the participant concerning ideal medical care. The common themes observed among the four community types included 'peace of mind because of the availability of medical care' and 'trust in medical professionals'. Themes that were characteristic of urban communities were the tendency to focus on the content of medical care, including 'high-level medical care', 'elimination of unnecessary medical care' and 'faster, cheaper medical care', whereas those that were characteristic of rural communities were the tendency to focus on lifestyle-oriented medical care such as 'support for local lifestyles', 'locally appropriate standards of medical care' and 'being free from dependence on medical care'. The sense of ideal medical care in urban communities tended to centre around the satisfaction with the content of medical care, whereas that in rural communities tended to centre around the ability to lead a secure life. By considering medical care from the geographical point of view, we found out the significant relationship between communities and perceptions of medical care ideals.
authors.affiliation: Division of Primary Health Care, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Ikai
authors.affiliation: Division of General Medicine, Nagoya University Hospital, Nagoya, Japan.
authors.forename: Tomio
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Osaka Center of Family Practice, Osaka, Japan.
authors.forename: Tamiki
authors.initials: T
authors.lastname: Oshima
authors.affiliation: Division of Environmental Health, Department of International and Social Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors.forename: Hitomi
authors.initials: H
authors.lastname: Kanayama
authors.affiliation: Division of Environmental Health, Department of International and Social Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors.forename: Yukinori
authors.initials: Y
authors.lastname: Kusaka
authors.affiliation: Division of General Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hayashi
authors.affiliation: Division of Promotion of Community Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Terasawa
mesh_terms: D000368:Aged; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan; D008019:Life Style; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D011788:Quality of Life; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data*; D012944:Social Support; D012945:Social Values; D014505:Urban Population / Q000706:statistics & numerical data*
keywords: Japanese communities; ideal medical care; residents’ viewpoint; rural/remote; urban