Journal of Health Care and Research

Journal of Health Care and Research

Hiroshi Bando^1,2iD*, Akiyo Yoshioka¹, Masahiro Bando^1,2, Yu Nishikiori^1
1Shikoku Division of Integrative Medicine Japan (IMJ), Tokushima, Japan
²Medical Research/Tokushima University, Tokushima, Japan

Corresponding Author: Hiroshi Bando ^{ORCID iD}
Address: Tokushima University /Medical Research, Nakashowa 1-61, Tokushima 770-0943, Japan.
Received date: 15 December 2024; Accepted date: 21 January 2025; Published date: 29 January 2025

Citation: Bando H, Yoshioka A, Bando M, Nishikiori Y. Basically Required Factors for Primary Care Medicine as ACCCC and for Psychosomatic Medicine as HEXACO. J Health Care and Research. 2025 Jan 29;6(1):8-11.

Copyright © 2025 Bando H, Yoshioka A, Bando M, Nishikiori Y. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.

Keywords: Primary Care, Psychosomatic Medicine, ACCCC, HEXACO Dimensions, Tokyo University Egogram

Abbreviations: TEG: Tokyo University Egogram; PC: Primary Care

Abstract

Basic concept and common philosophy exist in primary care (PC) medicine and psychosomatic medicine, such as a patient-centered point of view. In PC medicine, some factors have been necessary for actual clinical practice. They are Accessibility, Comprehensiveness, Coordination, Continuity, and Context or Contextual Care, which stand for ACCCC. For medical staff, some factors would be required for adequate management and consideration in clinical practice. They are Honesty-Humility (H), Emotionality (E), Extraversion (X), Agreeableness (A), Conscientiousness (C), and Openness To Experience (O) as HEXACO dimensions. Each dimension shows personal traits, which influence various behaviors and maintain our health and well-being.

Commentary

The author specializes in primary care (PC) medicine and psychosomatic medicine. He served as the president of the 8th Annual Conference of the Japanese Primary Care Association (JPCA) (2017) and the Japanese Society of Psychosomatic Medicine (JSPM), Chugoku-Shikoku Chapter (2023). PC medicine requires applicable social and medical construction. Furthermore, the humanity of each health worker is important in order to continue adequate management in PC medicine. Regarding psychological aspects, some research in the egogram and also personality structure models, such as HEXACO dimensions, would be required. This article provides an overview of these aspects.

In PC medicine, ACCCA was widely known as the main philosophy. It includes Accessibility, Comprehensiveness, Coordination, Continuity, and Accountability [1]. After this concept was widely adopted for years, a novel model has been proposed, where the last A was replaced with C as Context or Contextual Care. This is ACCCC, which has become mainstream in recent years [2]. There are frameworks such as ACCCA and ACCCC, but both have become guidelines for patient-centered care (Fig-1). Among these, comprehensive care refers to the provision of medical care across all medical specialties, from prevention to treatment and rehabilitation, focusing on common illnesses, while contextual care refers to care tailored to the patient’s circumstances. The people who actually play these roles are medical staff, who have excellent human qualities.

Fig-1: The concept of Primary Care with ACCCC

From a psychological point of view, transactional analysis (TA) has been evaluated as a useful measure [3]. TA was initiated by Dusay for personality trait theory [4]. It seems to be a satisfactory analysis method for better human communication. It includes types of egos, which are Critical Parent, Nurturing Parent, Adult, Free Child, and Adapted Child. Among several types of egogram methods, the Tokyo University Egogram (TEG) was prevalent in Japan, which has been adapted for various social situations in psychosomatic medicine, psychiatry, educational usage, and mental health [5]. The authors have continued several studies on Egogram [6,7].

As a novel method of evaluation for personality, the HEXACO model has been reported [8]. Its characteristics include a 6-dimension framework for evaluating human personality. The name HEXACO is derived from the acronym letters of the 6 dimension categories. They are Honesty-Humility (H), Emotionality (E), Extraversion (X), Agreeableness (A), Conscientiousness (C), and Openness To Experience (O). This concept can be shown by the scheme in Fig-2. Each dimension represents personal traits, which influence various behaviors and have the ability to maintain our health and support our QOL and ADL.

Fig-2: HEXACO model with 6 factors

In the latest report, the influence of six factors on the following categories was studied [9]. The categories were three health-related areas: mental health, physical health, and health-oriented behavior. The first were positive outcomes such as positivity, happiness, high self-esteem, and satisfaction. The second were physical fitness, its indicators, and the condition of the body. The third were health-promoting behaviors (regular exercise) and possibly worsening behaviors or risky actions (drug use, aggression, or gambling).

Six factors would be generally described as follows [9]. Honesty-Humility (H) shows traits related to fairness, modesty, sincerity, and greed-avoidance. It is strongly linked to moral behaviors, ethical decision-making, and self-regulation, associated with avoiding deviance, substance abuse, gambling, or risky sexual practices. For Emotionality (E), this trait tends to negatively impact mental health, such as anxiety and stress. In contrast, it can promote positive health behaviors, such as less engagement in risky activities, gambling, drinking, or other harmful matters. The dimension of Extraversion (X) reflects enthusiasm, sociability, and a preference for social communication. It is notable that the impact of (X) on health behaviors is equivocal. Although individuals with high (X) may engage in healthy activities such as exercising, they are also drawn to potentially harmful activities like excessive drinking or risky interpersonal interactions. Generally, (X) influences well-being, happiness, life satisfaction, and optimism, and is associated with adequate social connections.

Agreeableness (A) is related to patience, forgiveness, cooperation, and flexibility. Highly agreeable people tend to be warm, tolerant, and conflict-averse. They prioritize smooth relationships and harmony with quick reconciliation. As interpersonal harmony increases, stressful matters decrease, leading to a generalized sense of well-being. Regarding mental stability, higher agreeableness can provide fewer conflict opportunities and greater daily life satisfaction. The dimension of Conscientiousness (C) involves traits such as diligence, organization, prudence, and perfectionism. Highly conscientious people tend to be responsible, hardworking, and detail-oriented. They are likely to maintain a regular lifestyle with consistent exercise, moderate eating, and adherence to medical and health advice. Consequently, they tend to have physically healthy outcomes associated with stable self-control. Concerning Openness to Experience (O), it encompasses traits such as creativity, curiosity, imagination, and appreciation for novelty and the arts. People with high openness are often innovative with novel ideas and experiences. The effect of openness on mental and physical health tends to be weak because it includes both positive and negative influences.

For decades, practitioners and researchers have studied the relationships between health and personality domains. While previous reports focused on the Big Five traits, the latest report presented a meta-analysis of HEXACO domains derived from personality inventories associated with health outcomes [10]. Current HEXACO domains explain more variance in health outcomes than the Big Five domains [11]. As the Big Five domains did not sufficiently explain detailed outcomes, HEXACO domains provide greater variance in health outcomes. In some research findings, pro-sociality and ethical behavior showed significant associations with well-being in the Honesty-Humility (H) domain [12]. Thus, the HEXACO model may demonstrate higher criterion-related usefulness and validity for health outcomes compared to the Big Five model. HEXACO domains seem to provide specific health behavior outcomes and mental health insights but are less likely to explain physical health and medical outcomes.

In summary, basic concepts and common philosophies exist in PC medicine and psychosomatic medicine, such as a patient-centered point of view. Some factors are essential for ACCCC in PC and HEXACO domains for medical staff. This article will hopefully serve as a useful reference in developing clinical research and practice.

Conflict of Interest

The authors have read and approved the final version of the manuscript. The authors have no conflicts of interest to declare.

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