Is sekentei associated with reluctance to use formal care services?: A multilevel analysis in Japan

Objective: Japan, facing a faster-aging population than ever, has a problem concerning appropriate allocation of formal care services. Sekentei, which is a social-psychological process that restricts behaviors which do not conform to the social norm, is an important concept that reflects Japanese cultural values. It is possible that individual sekentei could be a factor associated with reluctance to use formal care services. The level of sekentei of the district in which a person lives could also have a bearing on the attitude toward seeking help from the care services. This study examined the relationship between individual and district levels of sekentei and the attitude to use of formal care services in the general Japanese population.

Methods: A cross-sectional survey was conducted by a mailed questionnaire from January to February 2005. The target population was 4,735 community residents, aged 20–75 years, living in Koka city, in Shiga Prefecture. Questions encompassed demographic data, attitude to use of formal care services, and the sekentei scale consisting of 12 items. The district variable of sekentei was constructed by aggregating the sekentei scores of individuals within the district.

Results: A total of 2,264 questionnaires were included in the analysis (valid response rate, 47.8%). Of the 2,264 valid questionnaires, 953 were completed by men and 1,311 by women. About 70% were reluctant to use formal care services. Individual levels of sekentei were positively correlated with age. A multilevel analysis showed that a higher individual level of sekentei was associated with a reluctance to use formal care services among men, and that higher individual and district levels of sekentei were associated with having reluctance to use formal care services among women. There was no interaction between the individual and district levels of sekentei among both men and women.

Conclusion: These results indicate that it would be important to assess not only the individual level of sekentei but also, particularly among women, the level of sekentei of the district in which they live in order to develop strategies to promote appropriate utilization of formal care services.