Factors Associated With Care Workers' Perceived Difficulty in Collaborating With Nurses on Bowel Care in Dementia Group Homes: A Nationwide Survey in Japan

Abstract

Background

This exploratory study aimed to identify factors associated with care workers' perceived difficulty in collaborating with nurses regarding bowel care in dementia group homes (GHs) in Japan.

Methods

We conducted a nationwide cross-sectional survey from July to October 2025. Using stratified random sampling, questionnaires were mailed to 2000 of 14,202 GHs listed in national open data. Of 437 responses (21.9%), 423 from care workers were included. Perceived difficulty was rated on a 0–10 numeric rating scale and dichotomized as difficulty (scores 6–10) or no difficulty (scores 0–5). Group comparisons and multivariable binary logistic regression were performed. Missing covariates were multiply imputed. A sensitivity analysis treated perceived difficulty as a continuous outcome.

Results

Of the 417 respondents with valid outcome data, 182 (43.6%) reported difficulty. Four factors were significantly associated with perceived difficulty. Older age (adjusted odds ratio [aOR] = 1.044, 95% confidence interval [CI]: 1.020–1.069), a stronger belief in the importance of abdominal warming (aOR = 1.222, 95% CI: 1.077–1.386), and greater uncertainty about when to report bowel-related concerns to nurses (aOR = 1.282, 95% CI: 1.175–1.398) were associated with higher odds of perceived difficulty. Longer caregiving experience (aOR = 0.939, 95% CI: 0.906–0.973) was associated with lower odds. Sensitivity analysis produced similar results.

Conclusions

Higher perceived difficulty was associated with older age, shorter caregiving experience, and uncertainty regarding the appropriate timing of consultation with nurses. Clarifying when care workers should seek nursing input may support more effective collaboration in bowel care.