Educational Program for Promoting Collaboration Between Community Care Professionals and Convenience Stores

Abstract

Convenience stores play an important role in supporting community-dwelling older adults’ lives. This study aimed to describe the development of and to evaluate an educational program to promote collaboration between communities and convenience stores in Japan. We developed the educational program based on interviews of convenience store staff to encourage them to collaborate with health/social care professionals for helping older adults. We conducted pre- and post-program questionnaire surveys of 184 participants to evaluate the program. After the program, the total score for attitudes toward dementia (p = .010) improved significantly among the convenience store staff. On the contrary, the score for “solidarity and proactiveness,” a subscale for sense of community, improved significantly among health/social care professionals (p = .003). This educational program can have a significant effect on the perceptions and attitudes for supporting older adults, depending on the participants’ occupations. This educational program could foster community networks, leading to an age-friendly community.

Keywords

ageism age-friendly society community gaming tool health/social care professionals home and community-based care and services

Introduction

To address issues associated with the country’s super-aging society, the Japanese government has introduced a community-based integrated care system that is designed to support older adults’ lives (Hatano et al., 2017). The concept of a community-based integrated care system includes mutual help among the community members, as well as self- and public help. Providing support to older adults, including those with dementia, should be the responsibility of all community members, including not only health care and social-service agencies and municipal governments, but also private-sector enterprises (Research Group of Community-Based Integrated Care, Ministry of Health, Labor and Welfare, 2013).

Convenience stores are private-sector enterprises that are familiar to community residents, including older adults. A convenience store is defined as a store that sells food and drink products, with a shopping area of 30 to 250 m² and service time of 14 hr or above in a day in Japan (Ministry of Economy, Trade and Industry, 2017). There are 50,000 convenience stores across Japan; in the Tokyo metropolitan area, more than 85% of the older population live within 300 m of a convenience store (Takemoto, 2016a). Such convenience stores support older adults’ lives, both through their functions of providing food and other necessities, and their physical characteristics, such as their moderate size and distance from older adults’ homes (Igarashi et al., 2018).

Moreover, in addition to providing necessities for daily life, convenience stores provide social support and promote older adults’ independence in the community. For instance, in a previous study, Igarashi et al. (2018) demonstrated that older adults in need of support/care gain benefits from convenience stores in terms of social activities, interaction with convenience store staff, and shopping necessities. Another study (Matsumoto, Igarashi, Suzuki, Yamamoto-Mitani, 2019) has also suggested that the existence of convenience stores contributes to independence in older adults’ lives. Disabled older adults who live in areas with higher accessibility to convenience stores were determined to be more independent in terms of their shopping behaviors than are those who live in areas with lower accessibility, indicating that older adults can go shopping by themselves if convenience stores are located near their homes (Matsumoto et al., 2019). Furthermore, convenience stores play a particularly important role for individuals with dementia, as the various types of support they provide help such individuals to continue living in their homes (Igarashi et al., 2018).

As populations continue to age, convenience store chain companies are beginning to recognize their importance for older adults’ lives and have expanded their services targeted toward older adults, such as meal-delivery services and eat-in spaces (Kodera, 2015; Takemoto, 2016a, 2016b). Furthermore, since 2005, the Japan Franchise Association (JFA) has engaged in safety-station activities, which include providing support for older adults, and has reported that approximately 20% of all convenience stores in Japan have contributed to safeguarding older adults with dementia in the past year (JFA, 2018). Many municipalities have also realized the ability of convenience stores to support older adults in the community and have concluded an agreement (“koureisha mimamori kyoutei” in Japanese) with convenience store chain companies to promote collaboration between the stores and municipalities regarding monitoring and supporting older customers (Nakamura, Matsumoto, Yamamoto-Mitani, Suzuki, & Igarashi, 2018).

Although convenience stores clearly play an important role in supporting older adults in their communities and are socially expected to collaborate with municipalities and health/social care professionals to help older adults through the community-based integrated care system (Research Group of Community-Based Integrated Care, Ministry of Health, Labor and Welfare, 2013), there are some obstacles to the collaboration, such as convenience store owners’ concerns regarding violating customers’ privacy and a lack of time for performing supporting activities due to daily work requirements (Yamanoi, Ishida, Asai, & Senoo, 2014). Considering this, we endeavored to develop a model for addressing these obstacles and promoting collaboration between convenience stores and health/social care professionals in the community care system. There appears to have been no previous study regarding the development and evaluation of a program for promoting collaboration between health care services and private-sector enterprises to support older adults through a community-based integrated care system.

We commenced an action research project for developing a collaboration model that involves convenience stores, health/social care professionals, and municipalities in providing support for community-dwelling older adults. The overall goal of the action research project was to build an age-friendly community in which older adults, including those with dementia, can live comfortably with all community members and are provided support by convenience store staff. As a strategy for promoting the collaboration, we developed an educational program to encourage convenience store staff to support older customers and to foster the creation of community networks that include convenience stores. This article describes the development process of the educational program and a preliminary evaluation of its effectiveness.

Method

This study was part of an action research project named “Nerima City Collaborative Project With Convenience Stores,” which commenced in 2015 in Nerima City, Tokyo Metropolitan Area (an area with a population of about 730,000 with an aging rate of about 22% in 2018). The action research is an industry–government–university collaboration project consisting of multidisciplinary professional members, including nursing researchers, home care service providers, and owners/managers of convenience stores, and employees of the municipal government. In Japan, almost all convenience stores operate under a franchise agreement with a convenience store chain company; owners of each store are responsible for the management of that store.

The research consisted of the following three steps: (a) interviews of convenience store owners, managers, and staff regarding their activities for supporting older adults and the difficulties they face; (b) program development based on the interviews; and (c) evaluation of the programs.

Interviews

To develop the educational program, we conducted interviews of owners/managers and staff members of convenience stores in an attempt to determine the activities they currently perform during their daily shifts to support older adults and the difficulties they encounter. Two sets of interviews were conducted during two separate periods; the first set was conducted from June to September 2014, and the second set was conducted from February 2015 to July 2016.

The subjects of the first set were 12 owners or managers of convenience stores located in regions throughout Japan and who had been honored by JFA for their excellent performance regarding helping older adults. For the second set of interviews, the subjects were eight owners/managers or staff members working for one of the four convenience stores located in the target area of the collaborative project; we performed three individual interviews with store owners and one group interview featuring one owner and three staff members. We performed a qualitative content analysis of the interview data to derive themes for convenience store staff’s support for older adults and the associated difficulties.

Prior to conducting interviews, the researchers provided the participants with written documents describing the aims and procedures of the survey and the voluntary nature of participation. Written informed consent was obtained from all participants.

Development of the Educational Program

Following the interviews, the members of the “Nerima City Collaborative Project With Convenience Stores,” comprising professionals from different fields, discussed issues that were identified during the interviews and the corresponding strategies to resolve them. Consequently, we developed an educational program to promote collaboration between convenience store staff members and health/social care professionals to support older adults.

Evaluation of the Educational Program

Although the overall goals of the program were to assist convenience stores in performing activities that support older adults and to build community networks that involve collaboration with convenience stores, in this study, we evaluated the feasibility of the educational program and the changes in participants’ perceptions of and attitudes toward supporting older adults, which comprised a preliminary evaluation.

Subjects

The subjects of the questionnaire survey were participants of the educational program, including convenience store owners/managers and staff members, health/social care professionals associated with community support centers and other home care service agencies, municipal employees, volunteer workers, and general people in the community. To recruit the participants, we asked convenience store chain companies, individual convenience stores, community support centers, home care service agencies, and community volunteer groups to participate in the educational program. Although we tried to recruit participants from the same community area to build their interpersonal relationships, which are useful in their daily work, we were unable to do so because of limited access, especially to convenience stores, during the recruitment.

Procedure

From May 2016 to July 2018, we held workshops providing the educational program 7 times in the community. The workshops were conducted for 90 min in easily accessible public spaces of the municipality, such as at community halls. During each workshop, researchers provided the participants with written documents describing the aims and procedures of the survey, the voluntary nature of participation, and that responses would be anonymous. Those who agreed to participate in the survey answered the questionnaire both before and after the program and submitted the questionnaires to the researchers upon completion.

Measures

We developed two types of questionnaires, with partly different question items, because the workshops’ purpose—developing the educational tool—was divided into two stages. In Stage 1, the workshop mainly aimed to evaluate the feasibility of the program, whereas in Stage 2, we focused on changing perceptions and attitudes through the program. In the questionnaire, we asked participants about their characteristics, subjective evaluations of the gaming tool used in the workshop, attitudes toward persons with dementia, sense of community, and their perception of the role of convenience store in supporting older adults, as shown in Table 1.

Table 1.

Goals and Measurements of Each Workshop.

	Stage 1May 2016 to February 2017 (five occasions)	Stage 2March to July 2018 (two occasions)
Purpose of the workshop	Evaluation of the feasibility of the program	Evaluation of changes in perceptions/attitudes
Characteristics measured through the questionnaire
Participants’ characteristics	○	○
Evaluation of the game	○	—
Attitudes toward dementia	○	○
Sense of community	—	○
Perception of convenience store roles	—	○

Participants’ characteristics, including age, sex, and occupation, were determined. Occupations included convenience store staff (owner, manager, staff, and employee of the chain company), health/social care professionals (staff of community support centers and other home care agencies in the community), and other community members (municipal employees, community volunteers, and general people).

The subjective evaluations of the gaming tool were only obtained after Stage 1 of the workshop. Three items were used for this measurement: the game was (a) “interesting,” (b) “easy to understand,” and (c) “informative.” These were rated using a 4-point Likert-type scale ranging from 1 (strongly disagree) to 4 (strongly agree).

The participants’ attitudes toward persons with dementia were determined at Stages 1 and 2. These were measured using the Attitudes Toward Dementia scale (Kim & Kuroda, 2011), which was rated using a 4-point Likert-type scale ranging from 1 (disagree) to 4 (agree). The Attitudes Toward Dementia scale comprises the subscales “tolerance” (five items), “refusal” (four items), “feeling of distance” (three items), and “affinity” (two items). Tolerance was measured using the following statement: “I can share joy and pleasure with people with dementia”; refusal was measured using the following statement: “I avoid, as much as possible, engaging with people with dementia”; feeling of distance was measured using the following statement: “people with dementia seem different to other people”; and affinity was measured using the following statement: “I can speak, without hesitation, with a person with dementia.” The internal consistency reliabilities of the total scale and of the individual subscales were acceptable (Cronbach’s alpha coefficient = .67-.79).

Sense of community was measured using the questionnaires administered before and after the Stage 2 workshops. This was performed using the short version of the sense of community scale (Ishimori, 2007; Ishimori, Okamoto, & Kato, 2013), which was rated using a 5-point Likert-type scale ranging from 1 (disagree) to 5 (agree). The scale for sense of community consists of the subscales “solidarity and proactiveness” (three items), “self-determination” (three items), “sense of attachment” (three items), and “reliance on others” (three items). Solidarity and proactiveness were measured using the following statement: “I want to act positively toward achieving a livable community”; self-determination was measured using the following statement: “it is important that residents make their own decisions regarding things that can improve the community”; attachment was measured using the following statement: “I feel pride in and attachment with my community”; and dependency on others was measured using the following statement: “it is acceptable for residents to leave activities that concern improving the living environment in their community to more dedicated people.” The internal consistency reliabilities of each subscale were determined to be acceptable (Cronbach’s alpha coefficient = .68-.92; Ishimori et al., 2013).

Finally, perceptions of convenience stores’ roles in supporting older adults were determined in the questionnaires administered before and after Stage 2. This was performed using a single question, “do you think convenience stores play an important role in older adults’ life in the community?” A 4-point Likert-type scale ranging from 1 (strongly disagree) to 4 (strongly agree) was used for responses.

Analysis

First, we calculated descriptive statistics for all variables. Second, we evaluated, using a paired t test and the Wilcoxon signed-rank test, the changes in total and subscale scores pre and post the program regarding attitudes toward dementia, sense of community, and perception of convenience stores’ roles for supporting older adults. The significance level was set at <.05 (two-tailed). Statistical analysis was performed using SPSS Statistics version 22.0 for Windows.

The ethics committee of the University of Tokyo approved the interviews and the questionnaire survey (Nos. 10821 and 11766, respectively).

Results

From the interviews, we derived some themes for convenience store staff’s support for older adults. Based on these themes, we developed an educational program and evaluated it through the pre- and post-questionnaire surveys. The following are the results of each step.

Interviews

Four themes for convenience store staff helping older adults in the store or during home delivery were derived from the interviews. The themes and their examples are listed below.

Theme 1: Daily helping behavior

The convenience store staff helped the older customers daily, such as for shopping and carrying the purchased items to the customer’s house:

An older customer had difficulty paying in coins at the register. A staff helped him/her to take the coins from his/her purse. (ID13, owner; ID16, staff)

Theme 2: Emergency helping behavior

The repeat older customers asked the convenience store staff for help during emergency situations, which in some cases was not related to shopping:

At midnight, a customer called the store to ask for help, saying: “I fell from my wheelchair. Please come to help me.” A staff member from the convenience store went to the customer’s house to help him/her. (ID6, owner)

Themes 3: Finding unusual conditions

The convenience store staff found unusual situations of older customers, such as a sudden illness at a store and not answering calls for delivery on the intercom. In such cases, they informed the police or called for an ambulance to help the customer:

A regular customer who always ordered by phone did not contact the store one day. So, a staff member went to the customer’s house and called him/her on the intercom, but the customer did not answer. The staff member then contacted a police station through a welfare volunteer and then entered the house. He found the unconscious customer lying on the floor, and rescued him/her. (ID3, owner)

Theme 4: Provision of information for health care agency

When the convenience store staff had trouble dealing with the behavior of an older customer, they tried to obtain the customer’s personal information and contacted municipal agencies such as the community support center:

An older customer regularly came to a convenience store, and always asked the staff the same question. Although a staff member asked the customer for his name and address, the customer did not answer, so the owner could not inform the municipal government or community support center about the customer. Consequently, the owner followed the customer on his/her way home to determine his/her address, and then gave the information to the community support center. (ID14, manager)

Dilemmas that arise when providing support to older adults

These themes demonstrate that convenience stores usually helped older adults and, in some cases, exceed their primary function of selling products. Daily helping behavior (Theme 1), in particular, occurred most commonly. Nevertheless, we noticed that the staff members faced difficulties addressing certain dilemmas regarding older customers; the difficulties tended to occur in themes other than Theme 1. In Theme 4, for example, the owner’s following of the customer raises an ethical dilemma between delivering personal profit (to the customer) and invading personal privacy. The profit for the customer is that the customer could receive appropriate treatment and support because the community support center’s staff learned of the customer’s need for help. On the contrary, the risk concerned surreptitiously obtaining the customer’s personal information (his or her address) without their consent.

Similarly, in the other episodes, we identified other types of dilemmas, such as “customers’ safety versus their personal privacy,” “customers’ personal safety versus staff’s safety,” and “customers’ self-determination versus their health.” These dilemmas were used as the basic framework of our educational program.

Lack of knowledge and relationship with health/social care professionals

Some episodes of the themes indicated the convenience store owners/managers’ and staff members’ limited knowledge regarding helping older adults and the lack of a relationship with health/social care professionals. For example, in Theme 1, the staff member reported helping an older customer pay with coins and found that the purse was full of coins; however, they did not know that an inability to pay using coins is a behavioral symptom of dementia.

Furthermore, in almost all episodes of each theme, the staff members helped the older adults from a personal rather than business perspective, usually without the support of municipal government or home care service agencies. Furthermore, they did not have any relationships with the health/social care professionals working for community support centers or home care service agencies. Therefore, when staff members worried about a customer’s behaviors or experienced any difficulties dealing with a customer, the staff members tried to contact a family member of the customer or a police officer, or even did nothing rather than contacting the community support center or health care professionals in the community.

Developing the Educational Program

Through the four themes, including the various dilemmas, and a lack of knowledge and relationship with health/social care professionals, we recognized the need for strategies to solve the issues mentioned. Consequently, we developed an educational program to address these issues and promote collaboration among various community members, including convenience store staff and health/social care professionals. The program was designed to promote convenience store staff members’ abilities to address difficult situations regarding supporting older adults, empowering them to act based on knowledge and a relationship with community members, including health/social care professionals.

The educational program included the following three elements: obtaining knowledge, fostering relationships, and collaboratively considering issues. First, the program provides basic knowledge regarding supporting older adults, including those with dementia. Second, a variety of community members, including convenience store staff and health/social care professionals from community support centers, participated in the program and got to know each other. Third, the participants discussed and considered the issues together.

The standard version of the program was 90 min in duration and comprised two parts: (a) a mini lecture for providing basic knowledge about older adults, including individuals with dementia, and (b) a gaming tool for discussing support for older adults in a small group. The program was named “N-impro” (an abbreviation of “Nerima,” the city name) and “improvisation” (considering and reacting extemporarily). The contents of the educational program are summarized below.

(a) Mini lecture for providing basic knowledge about supporting older adults: The mini lecture program, which was 10-15 min in duration, was developed to provide basic knowledge regarding means of supporting older adults, including individuals with dementia.

(b) Gaming tool to discuss support for older adults: We developed the gaming tool by referencing the methodology of a disaster education program created by Yamori, Kikkawa, and Ajiro (2005) and modified it to discuss dilemmas that can occur in a convenience store. The game consists of “situation cards,” “answer cards,” and “point cards.” The situation cards frame a three-part scenario: (1) assigning a role to the participant (e.g., you are a convenience store manager), (2) explaining a relevant dilemma situation, and (3) asking which choice (yes or no) the participant would make (Figure 1).

Figure 1.

Example of a situation card.

Eleven situation cards were developed, each presenting a different type of dilemma. The cards’ content was based on the episodes extracted during the interviews. For example, based on the episode introduced above as Theme 4, the following situation card was created:

You are a convenience store manager. You suspect one customer to have dementia and are worried about him. You have previously consulted a welfare volunteer about the customer, but she said she can do nothing until the name or address of the customer is identified. The customer visits your store irregularly, and you are unable to learn his name because his replies are unintelligible. Today, he has entered your store again. Will you follow him to his home in order to obtain his address? (Yes = you will follow him, or No = you will not follow him)

Similarly, we developed other situation cards based on other types of dilemmas mentioned.

Figure 2 shows the process of the game. Participants form small groups of five to seven persons. A facilitator then reads a situation card aloud and asks the participants what choice they would make in the situation in question. Each participant decides their answer and then lays the card face down in front of him or her, and when all participants are ready, they reveal their cards simultaneously. Participants whose answers are in the majority are deemed the winners, and each receives a point card (worth 1 point). However, if an individual is the only participant to make a particular choice, he or she receives a special point card (worth 3 points) for his or her valuable opinion because unique answers can potentially promote discussion and lead to profound contemplation among the participants. After distributing the point cards, the participants discuss the reasons for their choice. This discussion allows participants to learn the various points of view of the other members of their group and encourages them to consider the issues and strategies in depth.

Figure 2.

Process of the game.

Evaluation of the Educational Program

Altogether, 184 participants answered both the pre- and post-program questionnaires.

Participant characteristics

Table 2 shows the characteristics of the participants. The mean age ± standard deviation (SD) was 49.1 ± 14.6; 56% were female, and 48% were health/social care professionals, whereas 25% were convenience store staff members (i.e., convenience store owner, manager, staff, employee of a convenience store chain company).

Table 2.

Participants‘ Characteristics (n = 184).

	n	(%)
Age
M ± SD	49.1 ± 14.6
Sex
Female	94	(56.3)
Male	73	(43.7)
Occupation
Convenience store staff	43	(25.4)
Health/social care professionals	81	(47.9)
Other community members	45	(26.6)

Note. Percentages for each item were calculated after excluding the missing values.

Subjective evaluations of the gaming tool

For questions regarding whether the game was “interesting” and “informative,” approximately 80% of the participants answered “strongly agree”; meanwhile, for the question of whether the game “easy to understand,” 70% answered “strongly agree” (Table 3).

Table 3.

Subjective Evaluation of the Gaming Tool (n = 75).

	Strongly agree		Agree		Disagree		Strongly disagree
	n	%	n	%	n	%	n	%
Interesting	57	80.3	13	18.3	1	1.4	0	0.0
Easy to understand	49	69.0	18	25.4	4	5.6	0	0.0
Informative	58	81.7	13	18.3	0	0.0	0	0.0

Changes in attitudes toward dementia

The average score of attitudes toward dementia at the baseline (before the program) was 43.2; the average score of 39.4 of convenience store staff was comparable with the score of the general public (40.5), which was determined by a previous study (Kim & Kuroda, 2011).

For all participants, the total score and the subscale scores for “refusal” and “affinity” improved significantly after the program (p = .048, .005, and .013, respectively). When stratified by occupation, the total score and the “refusal” and “affinity” subscale scores only improved significantly among the convenience store staff (p = .010, .020, and .028, respectively); for other community members, the “refusal” subscale score improved significantly (p = .040). Meanwhile, the pre- and post-program scores for the health/social care professionals did not change (Table 4).

Table 4.

Changes in the Participants’ Perceptions of and Attitudes Toward Supporting Older Adults.

	All			Convenience store staff			Health/social care professionals			Other community members
	Pre M (±SD)	Post M (±SD)	p	Pre M (±SD)	Post M (±SD)	p	Pre M (±SD)	Post M (±SD)	p	Pre M (±SD)	Post M (±SD)	p
Attitudes toward persons with dementia	(n = 161)			(n = 33)			(n = 72)			(n = 41)
Total	43.2 (±6.6)	43.8 (±6.5)	.048	39.4 (±7.5)	41.1 (±6.9)	.010	45.5 (±6.1)	45.4 (±6.4)	.911	43.1 (±5.6)	43.5 (±5.9)	.569
Tolerance	16.6 (±2.7)	16.6 (±2.6)	1.000	14.8 (±3.2)	15.5 (±3.1)	.075	17.4 (±2.4)	17.3 (±2.6)	.819	16.7 (±2.2)	16.2 (±2.2)	.139
Refusal	11.3 (±2.2)	11.7 (±2.2)	.005	10.2 (±2.4)	10.9 (±2.3)	.020	12.2 (±1.9)	12.2 (±2.2)	.705	10.9 (±2.3)	11.5 (±1.9)	.040
Feeling of distance	8.9 (±1.9)	8.9 (±2.0)	.541	8.5 (±2.1)	8.6 (±2.1)	.574	9.2 (±1.7)	9.1 (±2.1)	.535	8.8 (±2.0)	9.0 (±1.8)	.568
Affinity	6.5 (±1.3)	6.7 (±1.2)	.013	5.8 (±1.5)	6.3 (±1.1)	.028	6.8 (±1.1)	6.9 (±1.2)	.183	6.5 (±1.2)	6.7 (±1.1)	.241
Sense of community	(n = 100)			(n = 12)			(n = 46)			(n = 34)
Total	48.0 (±6.6)	48.1 (±6.6)	.655	40.6 (±6.8)	39.1 (±7.9)	.259	49.4 (±5.7)	50.1 (±5.5)	.177	49.0 (±6.6)	48.9 (±5.6)	.772
Solidarity	12.1 (±2.2)	12.5 (±2.2)	.002	10.1 (±2.4)	9.7 (±2.5)	.776	12.2 (±2.2)	12.9 (±2.1)	.003	12.6 (±1.8)	12.9 (±1.8)	.106
Self-determination	12.5 (±1.9)	12.6 (±1.9)	.889	11.5 (±1.4)	10.4 (±2.1)	.083	12.8 (±2.1)	13.2 (±1.6)	.270	12.7 (±1.8)	12.6 (±1.9)	.837
Attachment	11.8 (±2.1)	11.7 (±2.1)	.599	10.2 (±3.2)	10.2 (±3.3)	1.000	12.2 (±1.6)	12.3 (±1.8)	.683	11.9 (±2.3)	11.8 (±2.1)	.417
Dependency on others	11.7 (±2.4)	11.5 (±2.4)	.398	8.8 (±2.0)	8.8 (±2.6)	1.000	12.2 (±1.9)	12.0 (±2.3)	.455	11.9 (±2.2)	11.9 (±2.1)	1.000
Perceptions of convenience	(n = 96)			(n = 12)			(n = 44)			(n = 31)
Store’s role	3.3 (±0.7)	3.5 (±0.6)	<.001	3.3 (±0.8)	3.3 (±0.5)	.655	3.5 (±0.6)	3.8 (±0.5)	.001	3.0 (±0.8)	3.3 (±0.6)	.026

Note. The statistics were based on paired t test for total score and Wilcoxon signed-rank test for subscale score.

Bold-faced values show statistical significance (p < .05).

Changes in sense of community

The average score of the sense of community scale at baseline was 48.0; it was higher than the score of the general public (36.8) determined by a previous study (Ishimori et al., 2013). This suggests that the participants in this study had a relatively high sense of community.

Although no participant showed any improvement after the educational program regarding their total score for the sense of community scale, overall the participants showed significant improvement in their score for the subscale “solidarity and proactiveness,” as did the group of health/social care professionals (p = .002 and p = .003, respectively). On the contrary, the group of convenience store staff members and other community members did not have any significant change in this regard (Table 4).

Perceptions of convenience stores’ role in supporting older adults

Perceptions of convenience stores’ role in supporting older adults improved significantly for the health/social care professionals and other community members (p = .001 and .026, respectively); however, the group of convenience store staff members showed no significant change in this regard (Table 4).

Discussion

We developed an educational program to encourage convenience store staff members to support older adults and to build a relationship between their convenience stores and health care professionals in their communities. The program was developed using actual episodes obtained from interviews of convenience store staff members. Almost all participants expressed positive opinions of the gaming tool included in the program, and their attitudes toward dementia and sense of community were found to have improved after the program, although the effects differed depending on the participants’ occupations. To the best of our knowledge, this is the first study to develop and evaluate a program designed to promote collaboration between health care services and private-sector enterprises in regard to supporting older adults through a community-based integrated care system. The results of this study should be useful for promoting the building of age-friendly communities in Japan and all over the world.

For several reasons, we believe that the program developed in this research can be effective for encouraging non–health care professionals in private sectors to involve themselves in a community-based integrated care system. First, the program features a gaming tool that is based on actual episodes that occur in convenience stores, which can attract participants to the program and motivate them to participate in the discussions. This is supported by the high level of evaluation of the gaming tool received from the participants in the present study. Second, the program includes a lecture concerning basic knowledge of dementia and means of supporting older adults and provides a mechanism through which participants can create relationships with each other. Consequently, the participants can effectively utilize the knowledge and the relationships they gain when considering the issues raised in the program. A previous literature review of a dementia education program for health care students revealed that the most effective educational intervention features class-based sessions followed by a practice-based experience (Alushi, Hammond, & Wood, 2015). Thus, our program, featuring simulative experiences of issues (through playing the game) and the delivery of knowledge (through the lecture), could have high effectiveness.

For each participant, the effectiveness of the program differed depending on their occupation. For convenience store staff, attitudes toward dementia improved, whereas for the other community members, “refusal” subscale scores improved. This accords with the finding of previous studies that showed that information and education regarding dementia can lead to better attitudes toward dementia among both the general public (Phillipson et al., 2018) and volunteers (Aihara, Kato, Sugiyama, Ishi, & Goto, 2016). The observed improvement in the convenience store staff members’ attitude toward dementia is important; the participants had relatively negative attitudes toward dementia at baseline as a result of a lack of knowledge, and the program was developed to focus on convenience stores. Also, for the other community members, the program was effective regarding palliating their refusal attitude toward dementia, as it fostered in them an understanding of dementia.

In contrast to the results for attitudes toward dementia, scores for the “solidarity and proactiveness” subscale of the sense of community scale improved among the health/social care professionals. Perceptions of convenience stores’ roles for helping older adults improved among health/social care professionals and other community members, including volunteers and municipal employees. Through the program, these people recognized that convenience stores support older adults’ lives, and became aware of their own contribution, in collaboration with various community members, including convenience store staff, in regard to constructing community care systems. However, regarding the convenience store staff, in this preliminary study we encountered recruitment limitations, and the participants were consequently unable to create community-based relationships with other participants from their own communities; therefore, we could not improve sense of community in the convenience store staff. In the next step of the community-based action research, we will encourage community support centers to use the developed educational program to build community networks that include convenience stores. Such an action could connect convenience stores and health/social care professionals in the community, leading to a fostering of a sense of community among convenience store staff in the future.

The methodology of the program could be used for holding training sessions regarding dementia in various settings. Although dementia supporter training programs in Japan have been shown to be partly effective regarding improving knowledge and perception of dementia (Matsuda et al., 2018; Miyano, Narimatsu, & Fujii, 2018), issues remain regarding motivating the general population to participate in the program (Uchida et al., 2016) and in encouraging the participants to support persons with dementia (Arakawa et al., 2016). The dementia supporter training program is provided mainly through classroom lectures, and its contents are general, rather than focusing on aspects that are relevant to certain participants; our program, with its situation-based gaming tool, may be an effective solution for these issues. Our program could contribute to the development of a revised version of such programs, expanding the target to general people or other community-based enterprises such as banks, libraries, and cooperative associations.

This study has several limitations. First, in this preliminary study, there was no control group, and the number of participants was limited; this means that our findings may be insufficient for determining the effectiveness of the educational program. In addition, a valid response rate of the questionnaire survey was not determined, because some workshops were held as community events, and thus, we were unable to know the total number of participants of the workshops. Second, we were unable to determine whether the changes in the score of the attitudes toward dementia and sense of community were clinically meaningful, due to relatively small differences in the value between the pre- and post-program. Third, we could not evaluate the long-term effects of the program, including the participants’ actual behaviors regarding helping older adults and community network building. In future, we plan to conduct an intervention study featuring a control group and a sufficient number of samples (comprising various community members from the same community area) and evaluate changes in the behaviors of the participants regarding helping older adults and their engagement in network building in the community.

In conclusion, we developed an educational program to facilitate collaboration between convenience stores and health/social care professionals in the community. After the program, attitudes toward dementia were determined to have improved significantly in convenience store staff and other community members, and a sense of community improved significantly in health/social care professionals. This program can be useful for increasing awareness about supporting older adults in the community, consequently contributing to the realization of an age-friendly community. In the ongoing action research project, the health/social care professionals working at the community support centers use the educational program to form relationships with community members, including convenience store staff, for their daily work. We will also evaluate the program’s dissemination throughout the community and its feasibility in professionals’ daily activities in the future.

Footnotes

Acknowledgements

We would like to thank all of the participants in this study. We would also like to acknowledge Mr. Satoshi Murata, Ms. Naomi Yanase, Mr. Shingo Aoki, Ms. Keiko Aburayama, and Mr. Hideto Yasui, members of the Nerima City convenience store collaboration project, and Mr. Masakazu Miyahara, Ms. Rie Goudo, Mr. Ryosuke Takada, Ms. Tomoko Okuyama, Mr. Nobuyoshi Kato, and Ms. Aika Yada from the Community and Cultural Affairs Division of Nerima City, Tokyo.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by JSPS KAKENHI (Grant JP15K15880) and Nerima City. This study was approved by the ethics committee of the University of Tokyo (Nos. 10821 and 11766).

ORCID iD

Ayumi Igarashi

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