Japanese health and safety information for overseas visitors: protocol for a randomized controlled trial

The number of overseas visitors to Japan has steadily increased over the last decade [1] from 8.6 million in 2010 to 31.8 million in 2019 [2]. Notwithstanding the disruption to travel caused by the COVID-19 pandemic, this number will continue to rise due to increasing global tourism, international conferences, and major sporting events [2]. The potential for public health issues among mass gatherings at these large events should be considered [3].

It is imperative that overseas visitors are able to access information about the health care system of the country they are visiting to reduce risks and enjoy a comfortable stay [4]. Wadhwaniya and Hyder [4] examined how overseas visitors obtained information and where they visited. Some of these visitors were immunized at clinics before travelling to developing countries, even though the health risks were not confined to those countries.

There are three main concerns associated with the low level of health information accessed by overseas visitors to Japan. First, overseas visitors tend to be young adults and think they are not very likely to become sick while travelling, but they are at high risk for injury [5]. Only 18% (45 out of 241) of overseas visitors, with a median age of 30–39 years, accessed information about the Japanese health care system in our previous study [6]. As one of the fastest growing host countries, Japan needs to rethink how its health care information will reach overseas visitors, including young adults.

Second, the effectiveness of pretravel health issue prevention is dependent upon the presentation and content of the information [7, 8]. Health information for overseas visitors is usually provided through websites, pamphlets, travel books, or visiting clinics in their home countries [7, 9, 10]. Currently, public health authorities of various countries provide health and safety information. This information is located at disparate places and may be inadequate for certain overseas visitors. Furthermore, much of the information is about infectious diseases and immunizations for developing countries [11‐13]. For instance, in our earlier study conducted before COVID-19, we concluded that overseas visitors are most concerned about medical costs, the Japanese language, and informed consent at clinics and hospitals, but there is not enough information to decrease these concerns [6, 14]. Third, although studies have confirmed that educational games are beneficial for sharing health-related information [15, 16], we have not found educational games that provide health-related information for travellers.

Overseas visitors generally consider Japan a developed nation that has a health care system with high standards. However, they do not know how to navigate the Japanese health care system should the need arise. Host nations have an obligation to provide accurate and useful information to overseas visitors about their health care system [17], illness prevention [18, 19] and procedures to access health facilities [14, 17, 20] in an efficient manner so that overseas visitors are not anxious about visiting other nations [4, 21]. Comprehensive and effective health education methods can convey vital information. Advancements in digital technology are driving changes, and information is now provided in several languages and in various formats [22]. These changes benefit most visitors, including young visitors, who are more likely to be at risk of injury when visiting foreign countries.

A digital game is an attractive way to distribute visually and culturally relevant information [23‐25]. In a previous study, a digital game on insulin therapy for children with type 1 diabetes was used, and non-supervised usage of the educational game “L’Affaire Birman” was able to improve insulin titration and carbohydrate quantification results [26, 27]. Another game used by general surgery residents in classrooms showed a significant increase in short- and long-term medical knowledge that was retained, with high learner satisfaction [28]. A separate study on lecturing nursing students showed that an educational game was both liked and accepted by the students and considered a satisfying teaching technique [16].

Digital games can also be used to share information on travel health with overseas visitors. In this research, we will evaluate the effect of a five-minute digital game titled Sa-Chan Japan (Table 1). We will examine the levels of satisfaction and motivation of overseas visitors to Japan regarding their educational experience.