The Fukushima nuclear accident in March 2011 posed major threats to public health. In response, medical professionals have tried to communicate the risks to residents. To investigate forms of risk communication and to share lessons learned, we reviewed medical professionals' activities in Fukushima Prefecture from the prefectural level to the individual level: public communication through Fukushima Health Management Surveys, a Yorozu ("general") health consultation project, communications of radiological conditions and health promotion in Iitate and Kawauchi villages, dialogues based on whole-body counter, and science communications through online media. The activities generally started with radiation risks, mainly through group-based discussions, but gradually shifted to face-to-face communications to address comprehensive health risks to individuals and well-being. The activities were intended to support residents' decisions and to promote public health in a participatory manner. This article highlights the need for a systematic evaluation of ongoing risk communication practices, and a wider application of successful approaches for Fukushima recovery and for better preparedness for future disasters.

After the Fukushima Daiichi nuclear power plant accident in 2011, Iitate village was placed under an evacuation order because the level of radioactive materials drifting from the nuclear plant to the village was above a government-set level for allowing residents to live in the area. The evacuation advisory for most of the village was lifted on 31 March 2017. For displaced residents deciding whether or not to return to their homes, it is important to correctly understand and estimate the realistic individual external doses they will receive after returning to the village. In this study, with the support of residents of the village, we used a personal dosimeter (D-Shuttle) coupled with a global positioning system device to measure and thus understand realistic individual external doses while the residents were in Iitate village and to project the individual external doses for different administrative districts as of 1 April 2017. The measured individual external doses measured by D-Shuttle for 38 study participants showed that the doses measured during time spent inside the village were higher and more widely distributed than the doses measured during time spent outside the village. The exposure ratio (ER) was defined as the ratio of additional individual external dose measured by D-Shuttle to the additional ambient dose based on an airborne monitoring survey. The medians of the average ERs were 0.13 (min-max 0.06-0.27) for time spent at home and 0.18 (min-max 0.08-0.36) for time spent outdoors. Projected additional annual individual external doses as of 1 April 2017 for different administrative districts in the village were calculated using ERs obtained in this study. Assuming that individuals spent 8 h per day on outdoor activities and 16 h on indoor activities, additional annual individual external doses were estimated to be below 3 mSv using the mean of the average ERs for most districts in the village, and these values were well below the individual external doses estimated using the approach taken by the central government. The results of this study provide valuable information both for understanding realistic radiological situations in the village and for those who want to know their future individual external dose in order to make a decision on whether or not to live in the village.

Following the accident at the Fukushima Nuclear Power Plant in March 2011, both experts and the national government provided insufficient information on radiation, leading to widespread distrust in the community. This study aimed at clarifying the association between anxiety about radiation and health literacy among residents in evacuation and non-evacuation areas in Fukushima. A questionnaire survey was sent to randomly sampled residents between August and October 2016, and data from 777 responses (38.9% valid response) were analyzed. The questionnaire assessed current radiation anxiety and discrimination and prejudice based on radiation exposure through seven items and communicative and critical health literacy through five items. Multiple regression analysis of the association between radiation anxiety and health literacy showed that the level of health literacy was significantly negatively associated with radiation anxiety in the evacuation areas (marginally in the non-evacuation areas) and marginally negatively associated with discrimination and prejudice in the evacuation areas but not in the non-evacuation areas. Therefore, improving health literacy could alleviate radiation anxiety.

Following the March 2011 accident at Fukushima Daiichi Nuclear Power Plant, many residents of Fukushima have faced anxieties about the health impacts of radiation exposure. Considering that source of information may influence resident anxiety, this study aimed to elucidate the correlation between the two. In addition, a health literacy query was included to examine a possible relationship between anxiety and health literacy skills. A mail survey was conducted in August 2016 among 2000 residents of Fukushima Prefecture aged 20 to 79 years. Survey items included questions about current health anxieties caused by radiation, trusted sources of information about radiation, and media used to obtain information on radiation. The survey valid response rate was 43.4%. Results of multiple linear regression analysis revealed that anxiety was significantly higher for the groups indicating “trust in citizen groups” and “use of internet sites.” Anxiety was significantly lower for the groups indicating “trust in government ministries,” “trust in local government,” and “use of local broadcast television.” Also anxiety was significantly lower for groups with higher health literacy. It was found that the significant relationship to anxiety varies depending on the sources of trust and media used. There is a possibility that this was caused by the difference between the contents of each information and media reports. In preparation for any future nuclear accident, government may consider action to improve the media literacy of residents. In addition, improving health literacy of both the recipient and the sender of information can improve access to information and thereby safeguard the health and well-being of the public.

In accordance with the study aims, we were able to demonstrate the utility of a questionnaire as an essential tool to plan and conduct effective communication between health professionals and primary family carers in Japanese cancer patients. This pilot test should be followed up with a larger sample and a controlled trial.