Measuring attentiveness toward oral care needs: a comparative study of Indonesian care workers in Japan and Indonesia

Hirano Y.O., Nugraha S., Shiozu H., Higashijima M., Rahardjo T.B.W.

Institute of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, Nagasaki 852-8520, Japan; Faculty of Health Sciences, University of Respati Indonesia, Jakarta, Indonesia; Department of Occupational Therapy, Chubu University, Kasugai, Japan; Faculty of Rehabilitation Sciences, Nishikyushu University, Kanzaki, Japan


Background: Japan has opened its labor market to care workers from Indonesia under the Japan–Indonesia Economic Partnership Agreement (EPA). However, few studies have examined the types of care skills transferred between countries. We therefore analyzed Indonesian care workers employed in Japan and Indonesia to identify discrepancies in their attentiveness toward oral care in older adults. Methods: A checklist comprising 42 items of universal oral care assessment was developed prior to the study and distributed via the Internet to 418 Indonesian EPA care workers in Japan and via a paper survey to 213 Indonesian care workers in Indonesia. The Mann–Whitney U test was used to compare the distribution of scores for each checklist item for each group. Results: The respondents were 110 Japan-based EPA care workers (response rate: 26.3%) and 213 Indonesia-based care workers (response rate: 99.1%). Japan-based care workers were significantly more likely to perform environmental observations of their older adult patients (p < 0.001) and to check items on the oral care checklist during feeding (p < 0.001) and post-meal (p = 0.001), while Indonesia-based care workers were more likely to check the overall condition of patients before meals (p = 0.021). Conclusions: Discrepancies in checking oral care between the two groups were attributed to the differences in laws and regulations governing the care environments. Indonesian care workers employed in Japan have the advantage of learning to employ a more systematic approach in caring for older adults, in accordance with Japan’s Long-Term Care Act. This approach could contribute toward lowering the risk of aspiration pneumonia in Indonesia. A training program designed for returning migrant workers to transfer newly developed oral care skills will thus be essential for Indonesia to diminish the negative impacts of its aging population. © 2021, The Author(s). Care skills transfer; EPA care workers; Indonesia; Japan; Older adults; Oral care


Human Resources for Health

Publisher: BioMed Central Ltd

Volume 19, Issue 1, Art No 71, Page – , Page Count

Journal Link:

doi: 10.1186/s12960-021-00614-y

Issn: 14784491

Type: All Open Access, Gold, Green


Labour and Welfare: Transition of number of entry (2020) Ministry of Health, ,, 20 Nov, In Japanese; Hirano, O.Y., Ogawa, R., Ohno, S., A comparative study of Filipino and Indonesian candidates for registered nurse and certified care worker coming to Japan under Economic Partnership Agreements (2012) Jpn J Southeast Asian Stud, 49, pp. 594-610; Alam, B., Wulansari, S.A., Creative friction: some preliminary considerations on the socio-cultural issues encountered by Indonesian nurses in Japan (2010) Bull Kyushu Univ Asian Center, 5, pp. 183-192; Hirano, Y.O., Rahardjo, T.W., Nugraha, S., The experience of Indonesian EPA nurse and care worker candidates in Japan (2016) Chiiki Kearingu, 6, pp. 87-91. , In Japanese; Labour and Welfare: The result of the 31st national board examination for certified care workers on EPA certified care worker candidates (2021) Ministry of Health, ,, May, In Japanese; Annex 10: Specific Commitments for the Movement of Natural Persons (2021) Ministry of Foreign Affairs. Agreement between Japan and the Republic of Indonesia for an Economic Partnership, ,, May; Hirano, Y.O., Yoneno-Reyes, M., Hiruma, Y., Nugraha, S., Reviewing EPA programs through the perception of EPA returnees (2021) Foreign nurses working in Japan: assessment of the EPA program, pp. 211-231. , Hirano YO, Yoneno-Reyes M, (eds), The University of Tokyo Press, Tokyo: Japanese; Hewko, S.J., Cooper, S.L., Huynh, H., Spiwek, I.L., Carleton, H.L., Reod, S., Invisible no more: a scoping review of the health care aide workforce literature (2015) BMC Nurs, 14, p. 38; Puffer, E.S., Annan, J., Sim, A.L., Salhi, C., Betancourt, T.S., The impact of a family skills training intervention among Burmese migrant families in Thailand: a randomized controlled trial (2017) PLoS ONE, 12 (3); Sumida, T., (2020) Current Conditions of Foreign Care Workers Entered Japan under EPA, ,, 20 Nov, In Japanese; Azarpazhooh, A., Leake, J.L., Systematic review of the association between respiratory diseases and oral health (2006) J Periodontol, 77 (9), pp. 1465-1482; Liu, C., Cao, Y., Lin, J., Ng, L., Needleman, I., Walsh, T., Oral care measures for preventing nursing home-acquired pneumonia (2018) Cochrane Database Syst Rev, 9, p. CD012416. , PID: 30264525; (2011) Demographic Statistics in Japan, ,; Teramoto, S., Fukuchi, Y., Sasaki, H., Sato, K., Sekizawa, K., Matsuse, T., High incidence of aspiration pneumonia in community- and hospital-acquired pneumonia in hospitalized patients: a multicenter, prospective study in Japan (2008) J Am Geriatr Soc, 56, pp. 577-593; Higashijima, M., Influence of age and bolus size on swallowing function: basic data and assessment method for care and preventive rehabilitation (2010) Am J Occup Ther, 64, pp. 88-94; Shiozu, H., Higashijima, M., Koga, T., Association of sarcopenia with swallowing problems, related to nutrition and activities of daily living of elderly individuals (2015) J Phys Ther Sci, 27, pp. 393-396; Higashijima, M., Murata, J., Ueda, T., Han, M., Clinical advantages of eating positions of the mid-neck on swallowing function (2012) J Phys Ther Sci, 24, pp. 837-840; Leopold, N.A., Kagle, M.C., Swallowing, ingestion and dysphagia: a reappraisal (1983) Arch Phys Med Rehabil, 64, pp. 371-373. , COI: 1:STN:280:DyaL3s3ot1Srtg%3D%3D, PID: 6882177; Davis, B.H., Smith, M.K., Developing culturally diverse direct caregivers for care work with older adults: challenges and potential strategies (2013) J Contin Educ Nurs, 44 (1), pp. 22-30; Sura, L., Madhavan, A., Carnaby, G., Crary, M.A., Dysphagia in the elderly: management and nutritional considerations (2012) Clin Interv Aging, 7, pp. 287-298. , PID: 22956864; (2018) Clinical Practice Guidelines for Diagnosis and Management of Dysphagia, ,; (2010) Manual of Oral Care Management Addition, ,, Accessed 31 Jan 2020 (In Japanese); Act on Public Health Nurses, Midwives, and Nurses., ,, Accessed 25 Dec 2019; Japanese Law Translation: Social Worker and Certified Care Worker Act, ,; Shanahan, T.K., Logemann, J.A., Rademaker, A.W., Pauloski, B.R., Kahrilas, P.J., Chin-down posture effect on aspiration in dysphagic patients (1993) Arch Phys Med Rehabil, 74, pp. 736-739. , COI: 1:STN:280:DyaK3szhvFChsw%3D%3D; Rasley, A., Logemann, J.A., Kahrilas, P.J., Rademaker, A.W., Pauloski, B.R., Dodds, W.J., Prevention of barium aspiration during videofluoroscopic swallowing studies: value of change in posture (1993) Am J Roentgenol, 160, pp. 1005-1009. , COI: 1:STN:280:DyaK3s3isl2msA%3D%3D; Logemann, J.A., Gensler, G., Robbins, J., Lindblad, A.S., Brandt, D., Hind, J.A., A randomized study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson’s disease (2008) J Speech Lang Hear Res, 51, pp. 173-183; Logemann, J.A., Kahrilas, P.J., Kobara, M., Vakil, N.B., The benefit of head rotation on pharyngoesophageal dysphagia (1989) Arch Phys Med Rehabil, 70, pp. 767-771. , COI: 1:STN:280:DyaK3c%2FisFOgtA%3D%3D, PID: 2802957; Yoneyama, T., Yoshida, M., Matsui, T., Sasaki, H., Oral care and pneumonia (1999) Lancet, 354, p. 515. , COI: 1:STN:280:DyaK1Mzpt1yksA%3D%3D; Yoneyama, T., Yoshida, M., Ohrui, T., Mukaiyama, H., Okamoto, H., Hoshiba, K., Oral care reduces pneumonia in older patients in nursing homes (2002) J Am Geriatr Soc, 50, pp. 430-433; Global Forum on migration and Development. Sixth meeting of the global forum on migration and development, Report of the proceedings, ,, Accessed 8 Aug 2020; International Labour Organization: Law on Protection of Migrant Workers (No. 18/2019)., ,, Accessed 29 Jun 2020

Indexed by Scopus

Leave a Comment