Is sekentei associated with attitudes toward use of care services? Multilevel analysis in Japan

Aim: To examine the relationship between individual and regional levels of sekentei and attitudes toward care services in the general Japanese population. Methods: A cross-sectional survey was conducted in January and February 2005 using a mailed-in self-administered questionnaire. Participants were 4735 community residents aged 20-75years living in 23 regions in the city of Koka in Shiga Prefecture. Questions encompassed demographic data, attitudes toward the use of formal care services and the Sekentei Scale. The regional variable of sekentei was constructed by aggregating the individual sekentei scores within elementary school districts. Multilevel logistic regression analysis was conducted to assess the association between individual and regional sekentei and attitudes toward care services. Results: A total of 2264 questionnaires were analyzed. Approximately 16% of respondents were willing to use formal care services. Multilevel analysis showed that lower individual sekentei was associated with the willingness to use formal care services among both men and women (odds ratio [OR]=0.96, 95% confidence interval [CI]=0.93-0.99 in men; OR=0.96, 95% CI=0.92-1.00 in women). Among men, the negative association between regional sekentei and the willingness to use formal care services was marginally significant (OR=0.69, 95% CI=0.48-1.01) as was the interaction between individual and regional sekentei levels. Conclusion: These results indicate the importance of assessing not only the individual sekentei level but also the sekentei level in different regions to develop strategies for the allocation of care resources.