Facilitating Factors for Implementing Multigenerational Exchanges in Regional Locations: A Cross-sectional Study in Niigata City, Japan

doi:10.21203/rs.3.rs-113001/v1

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Facilitating Factors for Implementing Multigenerational Exchanges in Regional Locations: A Cross-sectional Study in Niigata City, Japan

https://doi.org/10.21203/rs.3.rs-113001/v1

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published 25 Mar, 2021

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Background: In the process of community building, it is important to create a place for multigenerational exchanges. To consider the promotion of multigenerational exchanges in regional locations, it is important to clarify whether operational systems, regional characteristics, and social capital are related to the implementation of multigenerational exchanges and how these exchanges contribute to community building.

Methods: The participants were representatives from 455 Chiiki no Cha-no-Ma (hereafter “Cha-no-Ma”), and the study was implemented in Niigata City, Japan. There were 405 responses (a response rate of 89.0%), with the analytical target being the 401 locations that agreed to participate in the study. A cross-sectional study based on a self-assessment questionnaire method was implemented, and questionnaires were returned directly to the researchers after completion. The survey details included basic information (e.g., date of establishment, frequency of meetings, number of managers and users, qualification of the representative, etc.); characteristic of regional activities; a Social Capital Scale; the effects of the Cha-no-Ma being implemented by the representative (12 items); challenges for management (16 items); and the implementation of multigenerational exchanges.

Results: The items that had a significant connection to the implementation of multigenerational exchanges were “Frequency of meetings” (p < 0.001) and “Characteristic regional activities” (p = 0.026). With the relevant factors, a binomial logistic regression analysis was conducted, and the odds ratio for those with a high frequency of meetings was 3.839.

There was a significantly higher ratio of the implementation of multigenerational exchanges when the effects were a “connection with the region” (p = 0.006) and “conversations with different generations” (p = 0.004). There was a significantly higher ratio of the implementation of multigenerational exchanges when the challenge was “no support from residents” (p = 0.002).

Conclusions: To promote multigenerational exchanges in regional locations, meetings should be held at least once a week, with qualified personnel and the use of regional activities such as making local foods and festivals. It is clear from this community-based study that the implementation of multigenerational exchanges is an important activity for community building because it is related to connection within the community.

Health Economics & Outcomes Research

Health Policy

multigenerational exchanges

community building

social capital

community-based study

Japan is facing an aging society with a low birth rate and a projected shrinking population. The average number of family members is set to decrease from 2.33 in 2015 to 2.08 by 2040, and the number of solitary households is on the increase as well [1]. For older people to be able to live the rest of their lives in their own way in an environment that is familiar to them, municipalities and prefectures must establish an integrated community care system based on regional autonomy and independence [2].

In the process of community building, by promoting an integrated community care system, it is important to create a place of exchange for people. Over the past several decades, social isolation and loneliness among older adults have posed an increasingly urgent challenge because of the rapidly aging population in Japan. To remedy the situation, many communities have introduced multigenerational programs. In this situation, attention is being placed on the Chiiki no Cha-no-Ma (hereafter “Cha-no-Ma”), which have been implemented in Niigata City in Niigata Prefecture [3]. Niigata City has a population of approximately 800,000 and it is nearly 2 hours by bullet train from Tokyo. The population ratio of individuals aged 65 years or older was 27% in 2015, varying from 25.1–30.3% among districts. Niigata is famous as a rich rice-producing area in Japan. In 1964, it suffered a huge earthquake of M7.5, which caused significant damage. However, inhabitants cooperated and rebuilt the city. “Chiiki no Cha-no-Ma” can be translated literally as “community living room.” It is not a religious or political organization but rather a place where older people and mothers with children in the neighborhood can easily stop by and spend a pleasant time with people of different age groups. In 1997, Cha-no-Ma started with monthly regional exchanges that began in local community halls. They received attention for being locations that, rather than offering special programs, allow elderly people, the disabled, and mothers who are raising children to casually stop by and spend as much time as they like. Cha-no-Ma have developed as a form of citizen-led support using meeting places and vacant homes. With cooperation from social welfare councils and the Welfare Division of Niigata City, there are 500 or more locations open and operating in Niigata as of 2018, with the involvement of specialists such as public health nurses, hospital nurses, and occupational therapists. In the 2014 revision of the “Guidelines for health activities of public health nurses in the community” [4], the promotion of self-help and mutual support using social capital (e.g., community-based trust, social standards, networks and society-related capital, etc.) was newly included, and the Cha-no-Ma was identified as a base for regional activities by public health nurses. Furthermore, at Cha-no-Ma, where different generations can gather, multigenerational exchange effects are expected. Multigenerational exchange means that members of different generations can be present, feel welcome, and engage in activities [5]. Many of the effects of exchanges between generations have been shown in prior studies that focus on elderly people and children [6–11]. Moreover, Cha-no-Ma are expected to have the effect of community regeneration based on the connections between citizens through exchanges between generations, and some reports give attention to their positive effects in increasing social capital (hereafter “SC”) [12–15]. Cha-no-Ma are spaces where people from different generations can socialize and where staff including volunteers and users can interact rather than being separated, which ideally produces spontaneous multigenerational exchanges [16]. However, the current situation is that most of the participants are older people, and therefore, there is limited scope, prima facie, for actual multigenerational activity. Today, as activities such as Cha-no-Ma are expanding nationwide, what are the devices that can be utilized to promote multigenerational exchange in a local setting? The implementation of multigenerational exchanges in after-school care clearly shows the influence of an operational system of talent acquisition and location [17]. However, while after-school care is a government-led activity, Cha-no-Ma is a resident subject. Can an operational system influence the implementation of multigenerational exchanges? As the integrated community care system is not a nationwide approach, it needs to be carried out anew by each region [2]. Can regional characteristics influence multigenerational exchange? It is said that SC is strengthened through the activation of civic activity and that civic activity is promoted if SC is rich [18]. While the former has been confirmed in previous research, it has not yet been confirmed whether a rich SC has a positive influence on multigenerational exchange.

Therefore, in this study, we aim to clarify whether operational systems, regional characteristics, and SC are related to the implementation of multigenerational exchange in Cha-no-Ma. Further, we seek to clarify their relationship with the effect and challenges of Cha-no-Ma, investigating how the implementation of multigenerational exchange can contribute to community building.

Participants

The scope covered 455 Cha-no-Ma that were extant as of July 2019. Of those, 405 responded (a response rate of 89.0%), with the analytical target being the 401 locations that agreed to participate in the study.

Study Period

June to October 2019

Study method

This was a cross-sectional study based on the self-assessment questionnaire method. The distribution of the questionnaires was conducted by Niigata City, which organizes the Cha-no-Ma, and the questionnaires were returned directly to the researchers after completion.

Outcome Measures

The survey included basic information (e.g., date of establishment, frequency of meetings, number of managers and users, qualifications of the representatives, etc.); characteristics of regional activities; a Social Capital Scale (hereafter “SC Scale”); the effects of the Cha-no-Ma being implemented by the representatives (12 items); challenges for management (16 items); and the implementation of multigenerational exchanges. The conceptual overview is shown in Fig. 1.

The SC Scale of Kawaharada et al. [19] comprises 20 items across 5 grades; it was developed to measure the SC of the region from the perspective of the people living there. The internal validity was confirmed, with the Cronbach α coefficient being 0.92. Moreover, this scale allowed for an analysis of each factor; in this study, three factors were used to examine the residential region from the perspective of the representative, namely, “Factor 1: Trust and support of local people (7 items),” “Factor 3: Affinity with city professions (3 items),” and “Factor 5: Association in the neighborhood (3 items).” Answers for each were requested across five stages; the participants could respond with “Strongly agree,” “Agree,” “Neither agree nor disagree,” “Mostly disagree” and “Disagree,” with “Strongly agree” allocated 5 points and “Disagree” allocated 1 point. A higher score indicates a better condition of SC. The items for the effects and management challenges of Cha-no-Ma were created with reference to prior studies, [17, 20] with multiple selections being allowed.

Data analysis

Statistical analysis was performed using IBM SPSS Statistics ver.25 for Windows and a p-value of < 0.05 was considered to be statistically significant. For comparing the differences in characteristics between two groups, we employed Fisher’s exact test and Mann–Whitney U test. Logistic regression analysis was carried out with the implementation of multigenerational exchanges as a dependent variable and the related factors as independent variables.

Ethics Approval And Consent To Participate

All participants were informed about this study in writing before its commencement. Consent for participation was assumed on the basis of the return of questionnaires. We received approval from the ethics review board of our university as an ethical consideration (Approval number M2018-318; approved on April 19, 2019).

Basic information of participants

Table 1 shows the basic information of the participants. More than half of the Cha-no-Ma (236; 66.1%) was established in 2010 or thereafter. Furthermore, approximately 90% of the users were 75 or above or between 65 and 74. Multigenerational exchanges were said to be taking place in 125 locations (31.5%).

Table 1

Basic Information
		n	(%)
Frequency of meetings	Once or more per week	57	(14.2)
	Once/twice per month	344	(85.8)
Year of establishment	Prior to 1999	26	(7.3)
	2000–2009	95	(26.6)
	2010–2019	236	(66.1)
User age range	75 or above	357	(90.6)
	65–74	353	(89.6)
	40–64	145	(36.8)
	18–39	36	(9.1)
	Senior high school student	6	(1.5)
	Junior high school student	15	(3.8)
	Elementary school student	59	(15.0)
	Pre-school-age child	28	(7.1)
Multigenerational exchanges	Yes	125	(31.5)
Average number of users per day		18.0 ± 8.3
Average number of caretakers		4.1 ± 3.1
Average age of representative		72.3 ± 7.1

Factors related to the implementation of multigenerational exchanges

Table 2 shows the items that have a significant connection to the implementation of multigenerational exchanges. The ratio of multigenerational exchanges in the group with a higher frequency of meetings (once or more per week) was significantly higher (p < 0.001). Of the 135 specific descriptions of characteristic regional activities, the main items were related to food (49 items) such as “making local foods,” followed by items related to “festivals” (36 items).

Table 2

Items with a significant connection to the implementation of multigenerational exchanges
		Multigenerational exchanges present
Item		n	(%)	p-value
Frequency of meetings	High (once or more per week) n = 56	32	(57.1)	< 0.000
	Low (once/twice per month) n = 341	93	(27.3)	< 0.000
Specialist qualification of representative (nurse etc.)	Yes n = 78	32	(41.0)	0.026
Specialist qualification of representative (nurse etc.)	No n = 279	77	(27.6)	0.026
Characteristic regional activities	Yes n = 147	60	(40.8)	0.001
	No n = 217	53	(24.4)	0.001
Fisher’s exact test

Table 3 shows the items with a significant difference in the Mann–Whitney U Test. Those who implement multigenerational exchanges include a larger number of caretakers (p = 0.003).

Table 3

Items with significant differences in the implementation of multigenerational exchanges
	ME	Average rank	Median	p a
Number of caretakers	yes	221.44	4.50	0.003
	no	185.10	3.00	0.003
Score of SC (Factor I)	yes	209.77	27.00	0.003
	no	174.14	26.00	0.003
Score of SC (Factor V)
	yes	209.49	12.00	0.032
	no	183.83	12.00	0.032
Total Score of SC	yes	202.12	49.00	0.015
	no	173.32	47.00	0.015
A Mann–Whitney U test
Abbreviation: ME, multigenerational exchange; SC, Social Capital

Among the relevant factors clarified in Tables 2 and 3, a binomial logistic regression analysis was conducted to confirm the extent and the influence of exchanges between generations (Table 4). With consideration for collinearity, only the total score on the SC Scale was used for the items that were significant in the univariate analysis. Among the other items, there were no correlations of r = 0.2 or more. The odds ratio for those with a high frequency of meetings was 3.839.

Table 4

Factors related to multigenerational exchanges (multivariate)
	B	Standard error	Wald	Variance	P-value	Exp(B)	Exp(B) 95% confidence interval
	B	Standard error	Wald	Variance	P-value	Exp(B)	Minimum	Maximum
Frequency of meetings (1)	1.345	0.337	15.982	1	< 0.001	3.839	1.985	7.425
No. of caretakers	−0.074	0.047	2.513	1	0.113	0.929	0.848	1.018
Specialist qualification of representative (1)	0.785	0.297	6.998	1	0.008	2.193	1.226	3.925
SC Scale total	−0.030	0.019	2.669	1	0.102	0.970	0.936	1.006
Characteristic regional activities (1)	0.585	0.267	4.806	1	0.028	1.794	1.064	3.027
Constant	0.515	0.993	0.269	1	0.604	1.674
Binomial logistic regression analysis Forced entry method Model χ2 test p < 0.001 Hosmer–Lemeshow test p = 0.572
Note) Frequency of meetings High = 1, Specialist qualification of representative Yes = 1, Characteristic regional activities Yes = 1

Connection between effects and the implementation of multigenerational exchanges

When analyzing the connection between the implementation of multigenerational exchanges and the effects of so doing, a significant connection was found in 2 of 12 items (Table 5).

Table 5

Effects that show a significant connection to the implementation of multigenerational exchanges
		Multigenerational exchanges found
Effect		n	(%)	P-value
Connection with the region	Effect n = 264	95	(36.0)	0.006
	No effect n = 130	29	(22.3)	0.006
Conversations with different generations	Effect n = 96	42	(43.8)	0.004
	No effect n = 298	82	(27.5)	0.004
Fisher’s exact test

The ratio of the implementation of multigenerational exchanges was significantly higher when having the effects of a “connection with the region” (p = 0.006) and “conversations with different generations” (p = 0.004).

Connection between the challenges and the implementation of multigenerational exchanges

When analyzing the connection between the implementation of multigenerational exchanges and the challenges in doing so, a significant connection was found in 4 of 16 items (Table 6).

The ratio of the implementation of multigenerational exchanges was significantly higher when facing the challenge of “no support from residents” (p = 0.002).

Table 6

Challenges that show a significant connection to the implementation of multigenerational exchanges
		Multigenerational exchanges found
Challenge		n	(%)	P-value
Deficit in profits	Yes n = 19	11	(57.9)	0.020
	No n = 366	110	(30.1)	0.020
Poor transportation access	Yes n = 22	12	(54.5)	0.030
	No n = 363	109	(30.0)	0.030
No support from local residents	Yes n = 20	13	(65.0)	0.002
No support from local residents	No n = 365	108	(29.6)	0.002
Forming networks with other managers	Yes n = 25	13	(52.0)	0.027
Forming networks with other managers	No n = 360	108	(30.0)	0.027
Fisher’s exact test

Factors related to the implementation of multigenerational exchanges

As shown in Table 4, in this study, the higher frequency of holding meetings was the number one influencer on the implementation of multigenerational exchanges. It is thought that it is easier for children and working people to arrange their schedules if the meetings are held frequently. Morita et al. [17, 21] also reported that the implementation and continuation of exchanges between generations are affected by schedule adjustments. Furthermore, the amount of funding from the government in Niigata City depends on the frequency of meetings held. While locations where the meetings are held once or more per week receive up to 20,000 yen per month as well as an initial payment of 200,000 yen, those in which meetings are held once or twice a month receive a payment of only up to 2,500 yen per month [22]. Pain et al. [23] said, “More direct funding is needed for intergenerational programs,” and “Financial support and social policy support are critical for the long-term sustainability of intergenerational programs” [24, 25]. In these results, it was assumed that the budget would have the same connection, and it is thought that groups that meet once or more per week and receiving a larger subsidy, have better environments for the implementation of multigenerational exchanges.

Even if there is a desire to implement multigenerational exchanges, they cannot be put into practice if there is a lack of know-how. In this study, many of the representatives who said that they have specialist qualifications were nurses, educators, or childcare workers. The success of intergenerational programs is determined by the presence of a skilled healthcare professional and a qualified recreation therapist [26]. The most significant subcomponents regarding coordinator’s skills included being knowledgeable about different generations (e.g., children, youth, and elders) and having attended formal training on Intergenerational Program management [27]. As shown in these reports, essentially, when implementing multigenerational exchanges, there should be someone who has the role of a coordinator or facilitator. However, because of the current lack of personnel [17, 28], it is thought that the specialist qualifications of the representative affect the implementation of multigenerational exchanges.

Among the characteristic regional activities, there were several activities such as cooking together using local foods. As shown by reports stating, “The food-based activities worked well in bringing the groups together,” [29] exchanges with the theme of food were well-received by all generations. Furthermore, there were multigenerational exchanges through festivals based in the region. Festivals are tools of community gathering, intergenerational communication, and transmission of knowledge to the younger generations [30]. Food and festivals can be used to plan exchanges between generations.

However, it was expected that those with higher SC would have more multigenerational exchanges but no such significance was found by multivariate analysis. Because SC is becoming less diluted in today’s society, the operational system is considered to have a greater impact on the implementation of multigenerational exchanges than SC. In other words, it is possible to carry out multigenerational exchanges by establishing an operational system even in areas where SC is not established.

Effects of multigenerational exchanges

In this study, those who implement multigenerational exchanges reported the effect of a “connection with the region.” Exchanges between generations had the same effects as reported in prior studies, namely, a decrease in the risk of social isolation [5, 31], and the expansion of social networks [32–34]. Furthermore, according to the 2019 Annual Report on the Aging Society [35], of those aged 60 or over, the majority of people cited “support to and from neighbors” as being necessary to continue living happily in the region where they currently reside (55.9%). Looking at the different types of cohabitation, there was a higher ratio of two- or three-generation households living with their parents than single-person households or married couples, which shows not only that the elderly require support from the region but also that families with children and even grandchildren feel that it is a necessity. Community building requires the creation of connections with residents and with the region [36], and the multigenerational exchanges conducted at Cha-no-Ma can be considered useful in this regard.

The implementation of multigenerational exchanges also increases conversations with different generations, which has also been shown in prior studies [33]. In terms of exchange methods, it has been clarified that interactive programs increase the conversation level [6]. Conversations with different generations increase the knowledge level of each party more than that in the case of interactions with the same generation [37]. Conversation is expected to prevent cognitive deterioration [38, 39] for the elderly, improve attitudes toward older people [9, 10, 26, 40–44], and lead to the transmission of knowledge [17, 37] to children. Furthermore, communication is said to be an important factor in social capital [15], and conversations at Cha-no-Ma connect people so that conversations arise naturally in locations other than Cha-no-Ma, which is thought to lead to the effects of safety and observation.

Challenges posed by the implementation of multigenerational exchanges

While the implementation of multigenerational exchanges was found to have positive effects, it was also clarified that it poses challenges. Schemes such as enhancing programs for the provision of meals and the planning of festivals are required to implement multigenerational exchanges and involve a large budget. Therefore, it is important to secure a budget [23–25]. Regarding the problem of transport access, it is necessary, for example, to appeal to the city to introduce transportation services. A solution to the challenge of “no support from residents” may be found by proactively sharing information. The same is true for “forming networks with other managers,” which was also cited as a challenge. According to Ayala et al. [45], there is a need to network, collaborate, and/or partner with other organizations. In Niigata City, a “Cha-no-Ma School” is held every year to train the personnel who manage regional Cha-no-Ma [46]. Additionally, example activities are compiled [47] and published on the city website, and it is expected that going forward, the network of representatives will expand.

In this study, the survey was limited to Cha-no-Ma implemented in Niigata City, and the results may not necessarily be the same in other regions or countries. It is necessary to study the effects and challenges of the implementation of multigenerational exchanges in other regions while also considering the characteristics, environment and culture, etc., of the region. While this was a cross-sectional study wherein a quantitative analysis was implemented, it may be possible to gain more detailed information by conducting a qualitative study based on the results.

To promote multigenerational exchange in a regional location, meetings should be held at least once a week with personnel holding qualifications in areas such as healthcare, education, or childcare. Further, it is effective to make use of regional activities such as making local foods and festivals. As for future challenges, it is necessary to cooperate with the government in securing financial resources and transportation access. Actively disseminating case studies will help residents to understand and build networks collaboratively with other operators. It is clear from this community-based study that the implementation of multigenerational exchanges is an important activity for community building because it is related to an increase in communication with other generations and connection within the community.

SC: social capital

ME: multigenerational exchange

Ethics approval and consent to participate

All participants were informed about this study in writing before the start of this study. Consent for participation was assumed by the return of questionnaires. We received approval from the Ethics Review Board of Faculty of Medicine at Tokyo Medical and Dental University as an ethical consideration (Approval number M2018-318; approved on April 19, 2019).

Consent for publication

Not applicable.

Availability of data and materials

The data sets used and/or analyzed during the current study can be made available by the corresponding author on reasonable request.

Competing interests

No competing interests to declare.

Funding

This work was supported by JSPS KAKENHI (Grant Number 17K01817). The funding body had no role in the design of the study; the collection, analysis, and interpretation of data; or in the writing of the manuscript.

Authors’ contributions

KM contributed to the design, implementation, data-collection, data-analyses, and writing of the manuscript. MK and RA contributed to critically refining the article. HN, HY, FO, MH, HS, KMa, KMi, and AS were involved in conducting the study. All authors read and approved the final manuscript.

Acknowledgments

The authors would like to thank the representative of Chiiki no Cha-no-Ma, the staff of Niigata City and the Social Welfare Councils who took part in the study.

The authors thank Crimson Interactive Pvt. Ltd. (Ulatus) (www.ulatus.jp) for their assistance in manuscript translation and editing.

Authors’ information (optional)

Not applicable.

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Facilitating Factors for Implementing Multigenerational Exchanges in Regional Locations: A Cross-sectional Study in Niigata City, Japan

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