Introduction
Nuclear disasters necessitate responses during both the long-term recovery phase and the acute phase.Reference Li, Alves Dos Reis and Ansari 1 Responses during the acute phase include emergency radiation dose assessment and internal radiation contamination management, whereas those during the recovery phase include risk communication based on the citizen science approach and long-term health follow-up.Reference Li, Alves Dos Reis and Ansari 1 The health effects of nuclear disasters and required countermeasures differ significantly based on the disaster. For instance, the Chernobyl Nuclear Power Plant accident resulted in the acute radiation syndrome among emergency workers, increased incidence of thyroid cancer among individuals exposed to radioactive iodine, and a subsequent increase in mental problems among the afflicted residents.Reference Balonov 2 Following the 2011 Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, evacuation orders were issued for parts of 13 municipalities, and these orders have been gradually lifted.Reference Kobashi, Hasegawa and Yamashita 3 The health effects differed significantly from those of the Chernobyl Nuclear Power Plant accident.Reference Yamashita and Takamura 4 Although the number of patients with thyroid cancer did not increase due to radiation exposure,Reference Shimura, Suzuki and Yokoya 5 lifestyle-related diseases have increased.Reference Ohira, Nakano and Okazaki 6 Moreover, mental health issues due to the destruction of the pre-disaster community were reported.Reference Maeda and Oe 7 Thus, the health effects were diverse. Effective long-term strategies targeting public health are required to ensure optimal recovery after nuclear disasters.
Various countermeasures have been implemented to achieve optimal recovery after nuclear disasters. For instance, a previous study reported that seminars and dialogue with residents increased resilience.Reference Maeda and Oe 7 Furthermore, community resilience was associated with community networks, governance, and leadership.Reference Patel, Rogers, Amlôt and Rubin 8 In particular, previous studies have demonstrated that community recovery after disasters requires community-participatory initiatives that incorporate the needs of local communities.Reference Melton, De Fries, Smith and Mason 9 , Reference Keevers, Gough and Cameron 10 In the long-term recovery phase after a nuclear disaster, the needs of the local community change dramatically; thus, conducting frequent health needs assessments is crucial. Resident surveys have been conducted in municipalities that issued evacuation orders following the FDNPP accident to understand the needs of residents. 11 Previous studies have suggested that interviews are useful for conducting health needs assessments.Reference Kobashi, Goto and Chi 12 , Reference Kobashi 13 Further, a previous study reported the potential usefulness of interviews to community representatives, who worked in the community and heard the many direct voices of residents.Reference Kobashi 13 Nevertheless, studies using interviews to assess the health needs of residents recovering from nuclear disasters were scarce.
Namie was one of the most radioactively contaminated regions in the Fukushima Prefecture. The evacuation order was declared for the entire town on March 11, 2011. After decontamination and recovery, the evacuation order was lifted by the Japanese government in part of Namie on March 31, 2017; however, many parts of the area remained specified as the Difficult-to-return Zone. Approximately 21,500 residents were registered in Namie before the FDNPP accident, and this number decreased to approximately 15,100 residents in 2025. 14 Of these, approximately 2200 residents lived in Namie town, whereas the majority of residents lived in other areas of Fukushima Prefecture or other prefectures in 2025, although they were registered as citizens of Namie Town. 14 A 2024 survey of Namie residents indicated that 10.7% of residents currently lived in Namie, and 12.4% expressed a willingness to return to Namie in the future. 11 The majorly of residents expected improvements in medical facilities (86.2%), long-term care facilities (59.0%), and stores (58.1%). 11 Additionally, the Fukushima Institute for Research, Education, and Innovation was established in 2023, and the number of migrants from other regions has increased. Thus, conducting a qualitative study using interviews with Namie residents would provide a unique opportunity to assess their health needs after the lifting of the evacuation order.
Therefore, this study aimed to examine the health-related issues and proposed solutions among residents who had returned or migrated to Namie, as well as to identify vulnerable groups that faced difficulties in obtaining health services. In addition, this study aimed to clarify an effective method to identify the health-related issues among residents in disaster-affected areas.
Methods
Study Design
This qualitative study conducted semi-structured interviews with 16 participants who lived or worked in Namie Town (Figure 1). The participants consisted of five public health nurses, three clinical nurses, four government officials, and four general citizens (Table 1). This study included a variety of occupations to gather diverse opinions. The Ethics Committee of Fukushima Medical University waived the requirement for ethics approval, as the project fell outside the scope of the Ethical Guidelines for Medical and Biological Research Involving Human Subjects (reference number: REC2024-130).
Study site.
Participants’ characteristics (N = 16)
Interview Tool
To survey the health-related issues among residents who have returned or immigrated to Namie Town, a semi-structured, in-depth interview was conducted. Pre-designed semi-structured questionnaire was created before the survey, modified from an interview sheet for health needs assessment in the previous study.Reference Kobashi 13
To investigate the objectives of the present study, three specific Research Questions (RQs) were formulated.
RQ1) What health issues are problematic or of high priority among current residents of Namie Town?
RQ2) How can the health issues in Namie Town be resolved?
RQ3) Are particular groups of people more prone to health problems or less likely to receive services? If so, what health issues are problematic among these people?
A semi-structured interview tool formed by participants’ basic information, questions about pre-existing health issues, solutions to each presented health issue, and vulnerable groups.
Procedure
Purposive and snowball sampling methods were used to recruit participants in person. Informed consent was obtained from all participants before their participation. All interviews were performed by the first author in person or through video conference. The interviews lasted approximately 30 to 60 minutes. The interview was performed between November 2024 and December 2024.
Analysis
This study employed a thematic analysis to analyze the interview data. This study followed Braun and Clarke’s six-step method, including familiarizing, generating initial code, and defining themes.Reference Braun and Clarke 15 This study performed a thematic analysis for RQ1 and RQ2; however, it categorized and summarized items relating to health issues of vulnerable groups for RQ3, as this study focused on identifying vulnerable groups and their characteristics.
First, interview data were read repeatedly to familiarize the researchers with the data. Second, a coding procedure was performed to label similar data. Coding was conducted based on the RQs. Consequently, 69 codes were generated for RQ1 and 77 for RQ2 (Appendix A). Next, the 69 codes for RQ1 were categorized into 19 subthemes, which were subsequently grouped into 4 themes (Table 2). Furthermore, the 77 codes for RQ2 were categorized into 30 subthemes, which were subsequently grouped into 4 themes (Table 3).
Themes and subthemes relating to RQ1: prioritized health issues among Namie residents
Themes and subthemes relating to RQ2: solutions for improving health issues among residents
Generated themes and code were repeatedly reviewed by the researchers and refined based on the RQs. The analysis was performed using Microsoft Excel.
Results
Analysis in the present study identified eight themes. A total of four themes were identified for prioritized health issues among residents (RQ1): lifestyle-related disease (Theme 1), social isolation (Theme 2), inadequate medical care system (Theme 3), and mental health (Theme 4). A total of four themes were identified for solutions to health issues among residents (RQ2): improving lifestyle habits (Theme 5), enhancing medical services and nursing services (Theme 6), revitalizing the community (Theme 7), and providing personalized care and support (Theme 8). Each theme is associated with specific diseases (Themes 1, 4, and 5), connection to the community (Themes 2, 7, and 8), and the medical survival system (Themes 3 and 6).
Prioritized Health Issues Among Residents (RQ1)
Theme 1: Poor Lifestyle Habits Cause Disease
The majority of participants mentioned poor lifestyle habits causing lifestyle-related diseases. Some poor lifestyle habits were caused by specific situations.
Lifestyle-related diseases are caused by a lack of exercise due to changes in housing conditions. This is because the size of the house became small after the triple disaster.
High blood pressure is common in temporary housing. It might be caused by the stress of living in a temporary house.
Some people mentioned focusing particularly on type 2 diabetes.
Type 2 diabetes is very common in this area.
The thematic analysis identified two subthemes regarding locomotion: lack of exercise and frailty syndrome. The materialist society was associated with a lack of exercise.
People used to exercise by doing farm work, but when they were evacuated, they could no longer do farm work and stopped exercising.
Eating habits and alcohol consumption were mentioned in association with the disease.
People who have difficulty preparing meals, such as older adults and those living alone, often face challenges.
Many people in this town like Japanese sake.
Both extraordinary situations after the lifting of the evacuation order and common causes, including a lack of exercise and poor food habits, caused lifestyle-related diseases, including type 2 diabetes, in this area.
Theme 2: Social Isolation and Issues With Social Relationships in the Community
The majority of participants, particularly public health nurses, stated that the experience of evaluation disrupted invisible connections within the community that had been created over the years. Consequently, the lack of roles in the community reduced the sense of belonging to the community.
There is no one to talk to, no social role to fulfill, and no connections with neighbors.
The lack of human connection has a mental impact.
Even for those who had connections for decades, it becomes difficult to reconnect after a long period of separation.
The lack of invisible connections in the community, such as relationships with neighbors, affected migrant families from other regions.
There is social isolation due to the small number of mothers and their children, and the lack of people to connect with.
The subthemes of family issues, weak family relationships, and severe social withdrawal were identified. Thus, many human relationships were weakened, which could have been caused by the destruction of invisible connections within the community due to evacuation.
Theme 3: Inadequate Medical and Nursing Care Systems
The majority of people mentioned the lack of medical resources, both in terms of quality and quantity. In particular, access to specialist doctors was challenging.
When it comes to specialists, it takes 30-60 minutes by car to get to a hospital.
It is unclear which hospitals returning patients should go to. People often miss the opportunity to see a doctor and do not go.
People often don’t have a family doctor, and the doctors in charge frequently change.
Detailed blood tests and imaging tests are not available in this town.
Furthermore, the medical and nursing care for aging people had unmet needs, including end-of-life care, support for patients with dementia, rehabilitation, and social care.
There is insufficient support for the elderly.
Despite the efforts people have made to return to their hometown, where they are accustomed to living, they now have to receive end-of-life care elsewhere.
Rehabilitation facilities can often be difficult to access due to their remote locations.
The participants hoped to access medical and social care resources; however, some participants mentioned challenges regarding the availability of humane medical resources and the sustainable management of health care facilities.
Theme 4: Mental Health
Some participants mentioned issues associated with mental disease. This occurred in all generations. Moreover, they mentioned the lack of medical resources for residents with mental disorders.
There are mental health issues due to difficulty in building relationships when evacuees arrive in a place where there is no community.
There are mental illnesses, such as depression and schizophrenia.
Disorders in child development (lack of speech and emotional instability) are really common.
This study identified additional subthemes related to the prioritized health issues: fear of health effects from radiation, trauma among decontaminated workers, pests, lack of transportation, dispersed resources among local government staff due to resident relocation, lack of shopping facilities, and smartphone literacy.
Solutions and Countermeasures to the Prioritized Health Issues (RQ2)
Theme 5: Measures to Improve Lifestyle Habits
The participants noted the importance of opportunities to change their lifestyle habits. This was divided into two subthemes: exercise and food.
Functional training is challenging to do alone, and motivation increases when it is done in a group.
Various exercise opportunities should be available for individuals in settings such as at home, outdoors, and exercise classes.
It would be beneficial to improve nutrition through cooking classes.
Theme 6: Strength of Medical Services and Nursing Services
Various strategies were required to fulfill the unmet needs of medical care. Particularly, the majority of the participants mentioned access to specialist medical doctors.
People need to travel to Minamisoma or Koriyama for specialized medical care.
Many former private clinics have not returned.
We need to assign specialists in child psychiatry. It will increase the developmental consultation meetings.
Increasing the number of medical professionals would be beneficial.
Several subthemes were identified regarding solutions to improve the quality of medical care, including nighttime and remote consultation.
The role of bridging between doctors and patients, as well as introducing specialists, is not functioning smoothly.
A system to conduct CT, MRI, and additional blood tests should be established.
Nursing services and social support should be strengthened.
Currently, people must travel to distant care facilities, such as those in Iwaki.
Establishing rehabilitation facilities would be beneficial.
Providing transportation support and meal delivery services is vital.
Theme 7: Revitalization of Community and Connections
Three levels of solutions for revitalizing the community were identified: governmental, community, and individual. In particular, community-level solutions were mentioned by the majority of the participants.
In addition to exercise-related gatherings, it is necessary to have options for those who do not enjoy exercise (e.g., knitting, cooking).
Community leaders should be encouraged to take the initiative in organizing gatherings. The government should coordinate event planning.
Support for individuals who are unable to obtain information on their own should be strengthened.
Theme 8: Providing Personalized Care and Support
Solutions for the residents who required special and additional care were noted.
Establishing temporary childcare services and family support centers is required.
Many people returned due to difficulties adjusting to their evacuation locations.
People around individuals with mental illnesses often do not know how to interact with them.
Utilizing facilities and short-stay options is necessary to prevent family members from collapsing from exhaustion.
This study identified additional subthemes for solutions to prioritized health issues, including strengthening management capacity among administrators and grassroots-level education on radiation exposure evaluation.
The Vulnerable Group for Health Service (RQ3)
This study identified seven vulnerable groups from interview data (Table 4): Migrants from another region, Elderly men living alone or socially isolated individuals, Families with children, especially settlers or single parents, Elderly people, Residents with mental disease, Returnees who struggled in evacuation sites, and Men in their 50s to 70s unaware of their health conditions. The prioritized health issues in each group were derived from the results of a thematic analysis.
Groups of individuals vulnerable in terms of health services and health issues by group (RQ3)
Discussion
The interview surveys conducted health needs assessments among residents in the recovery phase after a nuclear disaster were limited. This study analyzed 16 participants who lived or worked in Namie, a disaster-affected area after the FDNPP accident, to investigate the prioritized health issues and the solutions for these. This study identified eight themes related to prioritized health issues and solutions.
The prioritized health issues were revealed to have three dimensions: disease, access to adequate health services, and community strengthening. The results identified two themes for disease (poor lifestyle habits cause disease and mental health), inadequate medical care and nursing care system for the theme of adequate health service, and social isolation and issues of connections in the community for the theme of strengthening the community. The report of the residents’ survey in Namie also revealed that the expansion of health and nursing service facilities was most required among residents. 11 In the residents’ survey in Namie, the community support for strengthening was also mentioned. However, the proportion of residents who need the community to be strengthened was low. 11 A previous study reported an increase in mental health and lifestyle-related disease in this area after the triple disaster.Reference Yamashita 16 Strategies were required to bridge the gap between residents’ health needs and current situations; the countermeasure might be designed from three dimensions: disease, adequate health services, and community strengthening. In addition, the arrangement of budgets for these prioritized health issues was important. To achieve this, advocating for the prioritized health issues, including the results of this survey, to the municipalities and the national government was vital.
The present study contributed to the idea that the needs and required solutions had a lot of diversity. This study identified seven vulnerable groups in the health services sector. Additionally, the results identified the theme of providing personalized care and support to address prioritized health issues. These narratives were created by service providers, including nurses, public nurses, and public officers in this study. A previous study also noted that vulnerable populations are strongly affected by disasters.Reference Bethel, Foreman and Burke 17 , Reference Flanagan, Gregory, Hallisey, Heitgerd and Lewis 18 To address the health needs of vulnerable populations, meticulous individual support and care were required.
The present study provided detailed and perspective information about health needs, which might be challenging to pick from a quantified residents’ survey. For instance, the narrative about socially isolated residents or residents with mental diseases, and the narrative of residents who were unaware of their issues, could only be obtained from care providers. To identify individual health needs and vulnerable populations, this type of survey should be conducted in both emergency and chronic recovery phases following a disaster.
The health care needs of residents dramatically changed in the reconstruction phase compared to the acute phase. The only health needs survey in the acute phase was the Resident Intention Survey. 19 In the acute phase, the residents prioritized the issues, including a decrease in radiation dose and the safety of the nuclear power plant. 19 Yet, after decades, the residents’ needs changed to more common issues, including general health issues. The COVID-19 pandemic may accelerate this tendency, as it has increased health care needs related to general medical care, and residents in this area have recognized the COVID-19 pandemic as a disaster.
Limitations
The present study had some limitations in generalizing the results. First, the majority of participants were women. In Japan, the proportion of women is higher among nurses and public health nurses. Second, the sample method was purposive and snowball sampling. This might cause selection bias. A well-designed sampling method is required for future surveys. Third, the method for conducting interviews to identify health needs among residents has not been established to date. This study interviewed four occupations, including general residents; however, the general method of interviewing to identify health needs should be determined in the future. Despite these limitations, the present study was the first interview survey to identify health care needs among those who returned to their hometown after a nuclear disaster.
Conclusions
The prioritized health issues were revealed to have three dimensions: disease, access to adequate health services, and community strengthening in the long-term recovery phase following a nuclear disaster. To confront the health needs of vulnerable groups, including migrants from another region, socially isolated individuals, and returnees who struggle in evacuation sites, meticulous individual support and care are required.
Supplementary material
The supplementary material for this article can be found at http://doi.org/10.1017/dmp.2025.10237.
Acknowledgments
We would like to thank everyone who contributed to providing crucial data. Furthermore, we are grateful to Prof. Shunichi Yamashita for providing us with constructive advice.
Author contribution
YK contributed to manuscript drafting, data analysis, communication with local stakeholders, study design, and reviewing the final manuscript. NS and ER contributed to the drafting of the manuscript and reviewed the final version. NI contributed to the study design, communication with local stakeholders, and reviewing the final manuscript.
Funding statement
This study was supported by Kaken-hi, provided to YK (grant number: 24K16778).
Competing interests
None.
