Experiences of professionals providing community care for disabled people in Nagasaki and Southampton.

Objective: To report on the factors affecting the resolution of problems experienced by community care professionals and to refine a checklist of methodological issues for future cross-cultural comparative studies.

Design: A preliminary comparative study between Japan and the UK.

Subjects: 630 subjects in Nagasaki, Japan and 109 subjects in Southampton, UK who were physically disabled, aged over 40 years, living at home and currently using at least 1 of the community disability care services.

Methods: Community care professionals from a range of professions were asked about the backgrounds, physical disabilities and needs of their disabled subjects, and the difficulties experienced in providing them with care and rehabilitation services.

Results: The proportion of subjects for whom difficulties were experienced in providing services increased with increasing severity of disability in Southampton. By contrast, this trend was less pronounced in Nagasaki where difficulties were reported in approximately 95% of all cases. However, it proved much more difficult to enlist collaboration for this survey in Southampton than in Nagasaki and this led to selection bias in the Southampton sample. The professionals in Nagasaki were hampered by a lack of medical information about their subjects and by a lack of available resources for relieving family members from some of their burden of care. The nature and impact of multidisciplinary team meetings appeared to differ in the 2 countries.

Conclusion: It is suggested that the provision of medical information and advice to staff working in community care is a factor of fundamental importance in enabling them to define objectives and to help identify disabled people's care and rehabilitation needs. The means by which such information and advice is shared appeared to differ in the 2 countries. Attenuated resources for community care and poor linkage between care organizations impair the ability of professional staff to resolve problems once they have been identified. It is suggested that each country could learn something from the other in improving the efficiency and impact of multidisciplinary community-based teams. In order to avoid the methodological difficulties in study design and implementation that we experienced, a 7-point checklist has been constructed to assist others who may be planning further cross-cultural studies in this field.