Buddhist temples as driving force of dementia-friendly society: a qualitative analysis of community-based integrated care in Buddhist temple caregiver cafés

Abstract

Objective

Outside the Japanese government’s community-based integrated care system, Buddhist temples are emerging as a resource to support caregivers of individuals with dementia living at home. However, we must critically analyze the views of secular professionals who are familiar with these activities. Thus, this study aimed to explore the characteristics and potential of caregiver cafés hosted in Buddhist temples from the perspective of healthcare and welfare professionals providing community-based integrated care by conducting two-step research: (1) a preliminary survey with Buddhist priests to understand the phenomenon; and (2) semi-structured interviews with staff providing community-based integrated care to explore its implementation.

Results

According to 13 Buddhist priests who organized the caregiver cafés, most temples held cafés once every month or two, while all collaborated with the community-based integrated care system. A thematic analysis of semi-structured interviews of 15 healthcare and welfare professionals identified two major categories (“temples as social resources” and “temples and priests leveraging their strengths”) and six subcategories from 143 discourses. The results indicated that temples and priests could be important social resources in community-based care systems by utilizing caregiver cafés in a society facing a shortage of care workers and an increasing number of individuals requiring care.

Introduction

As modern society ages, and the prevalence of mental illness is increasing in older adults [1]. Moreover, the number of people with dementia is increasing [2]. As the numbers of people with illnesses increase and young people decrease, it is essential to continuously update care systems for older people and their caregivers. Therefore, this study explored the connection between a novel social resource and the existing national care system.

The Japanese government is promoting the establishment of a community-based integrated care system to allow aging adults to continue living in the community [3]. However, some challenges are emerging: (1) a care worker shortage [4]; (2) ethical challenges with integrating the public and private caregiving sectors [5]; and (3) insufficient caregiver support [6].

The Japanese National Dementia Strategy includes “support dementia caregivers” using Alzheimer’s cafés as an example [7]. However, such café operators reportedly face difficulty finding participants (77%) and ensuring sustainability (60%) [8]. Buddhist temples support caregivers of individuals with dementia. While many global religious organizations contribute to social welfare by helping homeless individuals, immigrants, and war orphans, few have engaged in dementia care.

Buddhism, which originated in Japan and was introduced in China and Korea around the 6th century, now includes various denominations. Buddhism is deeply rooted in the Japanese culture, where it widely influences daily life. It is logical to redefine temples as social resources supporting a dementia-friendly society as follows: (1) they have a long history of supporting vulnerable people and those facing life difficulties; (2) their presence is significant (76,868 temples in Japan) [9] and outnumbers its 55,657 convenience stores [10]; and (3) priests have an incentive to cooperate with the secular care system by redefining the role of temples in community-based care systems.

The Jodo denomination, among the seven mainstream Buddhist denominations in Japan founded in Kyoto in 1175, supports the launch of caregiver cafés by member temples [11]; by 2024, approximately 30 temples offered caregiver cafés. In addition to Buddhist priests, an interdisciplinary team of social workers, psychologists, and psychiatrists develops operational manuals for such establishments [12]. The temples’ caregiver cafés are 2-h offerings in which participants discuss their caregiving experiences. Those who are current or former family caregivers are encouraged to participate. Anyone can participate regardless of their religious beliefs. The participants are informed of the ground rules: be a good listener, do not criticize, and keep what you hear confidential. Buddhist priests facilitate the meetings and do not proselytize.

According to a qualitative study, Buddhists believed that caregiver café activities aligned with Buddhist teachings, utilized the strengths of the temples, contributed to the personal growth of priests, and deepened their own faith [12]. However, this perspective stemmed solely from the priests’ perspective. To evaluate the rationale, feasibility, strengths, and fairness of temple use as resources within a community-based integrated care system, it is crucial to critically analyze the views of secular medical, nursing, and welfare professionals who provide such activities. Thus, this study explored the characteristics and potential of caregiver cafés hosted in Buddhist temples from the perspective of participating healthcare and welfare professionals.

Materials and methods

We adopted a qualitative descriptive approach [13] because it is useful in exploratory studies, in which little is known about the topic in question. The interviewees had their own unique perspectives on this new phenomenon, and the researcher role in this study was to analyze the interview data and identify themes rather than theorize. This involved two steps: (1) systematic questionnaire survey of Buddhist priests to grasp basic practices related to caregiver cafés; and (2) semi-structured interviews with staff providing care. This study was conducted between April 10, 2023, and March 18, 2024.

Preliminary survey with Buddhist priests

Participants

We interviewed priests from Jodo-denomination temples that hosted caregiver cafés (Fig. 1). This questionnaire aimed to assess the current status, effectiveness, and challenges of caregiver cafés and identify public collaborative organizations.

Fig. 1

A caregiver café at a Buddhist temple

Process

In April 2023, surveys were mailed to 18 Buddhist temples across nine prefectures that regularly organize caregiver cafés based on a list provided by the social affairs department of the Jodo denomination.

Survey items

The questionnaire collected demographic information about the priests (sex, age, and temple position) and caregiver cafés (duration, frequency, and average participation). It also explored (i) motivations for initiating the café, (ii) positive impacts, (iii) challenges faced, and (iv) changes in the priests’ feelings since starting the café.

Analysis

The simple descriptive data collected herein were analyzed to guide the subsequent phases of the project.

Semi-structured interviews with staff providing community-based integrated care

Participants

Semi-structured interviews were conducted of staff from secular public organizations involved in the community-based integrated care system, such as support centers, social welfare councils, and nonprofit organizations, who participated in the caregiver cafés at Buddhist temples.

Process

Semi-structured interviews were conducted between September 2023 and March 2024 with staff members referred by temples during the preliminary survey. All participants provided written and verbal consent.

Interview questions

The interviews covered participants’ reasons for participating in the cafés, their roles, the insights gained, café effectiveness, and how these cafés differed from other caregiver groups.

Analysis

The interviews were recorded, transcribed verbatim, and analyzed for themes by the first and second authors using a thematic analysis. All transcripts were thoroughly reviewed to classify and code the discourses that evaluated the temples, priests, and caregiver cafés into hierarchical themes. Subcategories were generated only upon being discussed by at least two individuals.

Positionality

This study was not conducted to benefit or indicate the superiority of any particular religion or denomination. Rather, it explored working with existing resources to complement the National Dementia Strategy when faced with increasing older and declining younger populations. The Jodo denomination was chosen as the target group because, as mentioned previously, it was the only denomination that had systematic information about caregiver cafés.

Results

Preliminary survey

Thirteen of 18 Buddhist priests responded (response rate, 72.2%). Among them, five were in their 40s, four in their 60s, two in their 50s, one in his 30s, and one in his 20s. The caregiver cafés had operated less than 1 year to more than 6 years. One temple held a café quarterly, half held a café once monthly, and the other half held a café bimonthly. The number of participants in these cafés varied from three to 20. Moreover, all temples cooperated with public care institutions. Specifically, community-based integrated support centers and social welfare councils assisted with publicizing these cafés and providing information about necessary care and support to the participants.

In the open-ended section of the questionnaire entitled “Motive for holding the café,” many statements touched upon recent local challenges and the desire for temples to serve as community resources. Common themes included providing space for caregivers to discuss their concerns and personal caregiving experiences as well as efforts to maintain and revitalize temple functions. In the section entitled “The effectiveness of the café,” respondents noted a positive change in participants’ perceptions and reaffirmed their appreciation and value of the temple. Regarding “difficulties or burdens,” nearly half of the priests (n = 6) reported no particular challenges, while others mentioned difficulty related to promoting the café, securing participants, and facilitating the events. In the “change in mindset” category, only two priests reported no particular change or provided no response, indicating that the majority experienced a shift in perspective. They realized that the participants trusted them enough to speak openly from the first meeting, recognized that temples are places for expressing unresolved issues and feelings rather than offering solutions, and understood the importance of the temple’s involvement in Buddhist memorial services and broader societal issues. Caregiving, previously seen as other people’s concern, became personally relevant. Additionally, some respondents noted that, since the launch of the caregiver café, the priests made various social contributions via the temples. There have also been calls for more active engagement in social activities by specific denominations.

Semi-structured interview

Responses were obtained from 15 staff members involved in the community-based integrated care system: four were male and 11 were female; one was in their 20s, six were in their 40s, three were in their 50s, four were in their 60s, and one was in their 70s. Six belonged to a community-based integrated support center, four to the Council of Social Welfare, one to the Medical Center for Dementia, three to nonprofit organizations, and one to other organizations. The population included seven social workers, one public health nurse, three volunteer citizens, and four others who were dementia-friendly community promoters and were appointed by the local government; a citizen who received a training course on everyday life support; a secretary-general from the welfare council; and a chairperson of the executive committee of the dementia café.

A thematic analysis of the 143 discourses led to the identification of six subcategories. Similar subcategories were combined into a single category and ultimately consolidated into two major categories. The major category “temples as social resources” identified temples as key social resources for caregivers and included “temples as places where people can belong and talk,” “temples as familiar and open to the community,” and “fair temples.” The other major category, “temples and priests leveraging their strengths,” rated temples and priests as unique qualities and included “unique atmosphere of temples,” “temples for grief and spiritual care,” and “sense of trust in temples and priests” (Table 1).

Table 1 Characteristics of caregiver cafés held at temples, as extracted from narratives of community-based integrated care staff

Discussion

In this study, the discourses of professionals from formal care systems about caregiver cafés in the temple revealed two key factors: “temples as social resources” and “temples and priests leveraging their strengths.”

The category “temple as a social resource” stated that temples could be essential components of community-based integrated care. The subcategory “familiar temples open to the community” indicates that temples appeal to their followers as well as broader local stakeholders. In contrast, “fair temples,” i.e., temples being operated fairly and not proselytizing or practicing excessive solicitation, were mentioned. All temples in this study established partnerships with public organizations. Such partnerships help temples gain the trust of the community and its residents and become essential components of the care system. The category “temples and priests leveraging their strengths” is consistent with that of a previous study [14] from the priests’ perspective, meaning that the priests and the staff of the secular community-based care system agree with each other.

Historically, Buddhism supported wide areas of people’s lives in Japan, including their medical care [15]. After the Meiji Restoration in 1868, which aimed to establish a modern and strong nation-state, the new government developed a modern medical care system following the German model. Since Buddhist temples are known to be managed mainly on the income from funeral rites and mourning services, they are often criticized as “funeral Buddhism” facilities, meaning that Buddhist priests focus on holding rites for the deceased rather than helping living people. In response to this criticism, an interfaith chaplaincy program [16] was established in which religious workers and priests visit disaster areas to serve people in crisis without proselytizing. However, only 212 interfaith chaplains exist in the country, far from a universal system [17]. This is because the system is too burdensome for ordinary priests who maintain their temples and serve distant people. Accordingly, our results suggest that carer cafés are a reasonable and realistic method for temples to use their strengths to serve their communities.

Limitations

This exploratory study was based on the discourse of 15 staff members within a limited period. Thus, more multifaceted, long-term, and quantitative research is required to verify the effectiveness of these interventions from the perspective of caregivers participating in such cafés. Additionally, because the caregiver cafés in this study were conducted by a stable classical Buddhist order with a long history, nothing can be drawn from this study regarding newer, more missionary-minded religions.

Conclusions

Our findings suggest that Buddhist temples and priests can become important social resources in community-based care systems by utilizing the strengths of caregiver cafés.