© A. Goto et al., Published by EDP Sciences 2026

1 Introduction

Japan is a disaster-prone country. In 2011, a Fukushima nuclear power plant accident occurred following a massive earthquake and tsunami. When facing disasters, prompt responses to convey emergency information and connect people with support services are needed. Digital technologies could improve the responses before, during, and after disasters regardless of affected people’s geographical locations or even disaster types (Madanian et al., 2020).

The digital tools are increasingly integrated into our daily lives. Such advances in digital technology allow health services to be delivered swiftly and beyond geographic boundaries. Therefore, people’s ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem (eHealth literacy) (Norman et al., 2006) would be important for navigating themselves in a health system and accessing health services. A recent meta-analysis reported that eHealth literacy, often measured by the eHealth Literacy Scale, correlated with health behaviors (Kim et al., 2023).

One of the guidelines for developing digital tools in the nuclear disaster context recommends preparing the tool that takes into account the well-being of vulnerable people, including children, pregnant women, people with disabilities, older people, and migrants (Shamisen Sings, 2020). As for the gender aspect, digital health is reported to be rarely designed from a gender equity perspective (Figueroa et al., 2021) and significant gender gap is reported in the usage of digital tools (Yumiya et al., 2021, UNESCO, 2019). International survey results reported by UNESCO showed that boys with mobile phones used them for a wider range of activities than girls in adolescence, early adopters of new technology are overwhelmingly men among college students, and only about 10% of machine learning researchers were women (UNESCO, 2019). Such a gender gap in digital skills exists across regions, and among the Organization for Economic Cooperation and Development member countries, Japan indicated the lowest share of women among all tertiary graduates in Science, Technology, Engineering, and Mathematics (STEM) (OECD, 2025).

In this research, we explored the gender differences in people’s knowledge, attitudes, and practices (KAP) with respect to the use of digital tools for radiation protection in the event of a nuclear emergency in Japan. The digital tools can include a variety of technologies, including information and communication technology, sensor devices, and artificial intelligence. In this study, we focused our attention on mobile applications or personal devices, as was the focus of our previous project funded by the Ministry of Environment in Japan (Ohba et al., 2020).

2 Methods

We conducted a secondary analysis of anonymous data collected in an internet-based needs survey to develop a mobile application for radiation protection and health promotion among the people affected by the Fukushima nuclear accident. Therefore, this study did not use any data involving human subjects.The original study was approved by the Fukushima Medical University Ethics Committee (No. 2019-133).

The survey included data on people’s eHealth literacy levels and KAP (knowledge, attitude, and practice) in relation to a digital tool for radiation protection and health promotion as well as basic characteristics (gender, age range, education level, occupation, living conditions), knowledge of radiation, and concern about the risks of NPSs (Ohba et al., 2021). The survey was conducted from January 31 to February 4, 2020, and managed by an Internet survey company, INTAGE Research Inc. The company collaborates with NTT Docomo and Marketing Applications and manages an online survey monitor pool of over 10,000,000 people. These participants are recruited through internet advertisements and are given gift points as a reward for taking part in the surveys. The pool includes an equal proportion of women and men and is characterized by the highest age group in the 50s (intage, 2024). A smaller proportion of those in their 60s or over is included in the women group (women 20.0%, men 35.8%). The monitor recruitment for the original data collection was based on the stakeholder state in the case of a nuclear emergency, residential area (area affected by or close to a nuclear power plant), and age.

As for the KAP items of radiation related mobile apps, Knowledge was measured by asking, “Are you aware of any mobile apps or personal devices that allow you to conduct your own radiation dose measurements?”. Attitudes were assessed with the question, “Would you be interested in using a mobile app to measure radiation during and after a radiation incident?”. Practice was determined by asking, “Have you ever used any mobile apps or devices for radiation measurements?” The response options were “yes” or “no.”

As for the eHL level, we used a standardized Japanese version of the eHealth Literacy Scale (Mitsutake, 2011). The measurement has 8 items rated on a 5-point Likert scale, and the total score ranges from 8 to 40. In addition, we analyzed qualitative data to an open question asking, “Please write your opinions about radiation and health.” Respondents were instructed to write “not sure” when they did not have any opinions, and these were excluded from the analysis.

Gender differences (in traditional binary categories) in basic characteristics and KAP for radiation assessment digital tools were observed using a Chi-square test for categorical variables and a t-test for a continuous variable. When the gender difference for KAP was observed in the univariable analysis, we examined whether gender was associated with KAP controlling for other factors (basic characteristics and eHL level) using logistic regression analysis with forced entry. All analyses were conducted using STATA BE 18. As for qualitative data, text mining analysis was performed using KH Coder free version 3. Correspondence analysis was used to visualize differences in the use of nouns (that appeared three or more times) between women and men.

3 Results

The data from 339 participants was examined. Half of the respondents were women, and 29.5% were 60 yr old or over (Tab. 1). The proportion of those aged 60 or over was higher for men and not married was higher for women. The average eHL score for everyone was 24.0 (SD 5.6), and there was no notable difference between men (average 24.0) and women (average 23.9).

For the KAP assessment (Tab. 2), over 70% were interested in using the radiation protection app with no gender difference. However, for the self-assessment of knowledge (men 38.2%, women 23.5%) and the actual use (men 16.8%, women 4.8%) of the tool, a substantially higher proportion of men answered positively. We then performed multivariable analysis and found the gender difference remained for both knowledge (adjusted odds ratio [aOR] for women 0.56) and practice (aOR for women 0.27) after controlling for the items in Table 1.

As for the opinions on using the radiation protection app (Tab. 3), more men answered they felt relieved, and more women answered they thought the tools were not useful. When asked about what functions they expect to be installed in the tools (Tab. 4), with no gender difference, the top functions were environmental radiation measurement, measurement in foodstuff, official real-time radiation measurement, and general information on radiation. Among those who self-reported to live or have lived in contaminated areas (n=53: men 34, women 19), a higher proportion of women reported taking measures to minimize exposure through being selective of drinking water (men 29.4% and women 42.1%) and local foodstuff (men 38.2% and women 63.2%) (data not show in a table).

Text-mining analysis of qualitative data showed that words that were characteristic to women were “government,” “organization,” “interest,” “vegetable,” “medical care,” “damage,” and “methods,” and those to men were “myself,” “status,” “specific,” and “radioactive material.”

4 Discussion

Among our survey participants, both men and women showed a high interest in the radiation protection digital tools, but more men acknowledged their knowledge and actual usage of the tools. More men felt relieved among actual users of such tools, and more women voiced these were not useful. The text analysis revealed that women were more interested in daily living, including food and medical care. This is consistent with our quantitative data that more women living in radionuclides’ contaminated areas were careful about drinking water and consuming local foodstuff. It is assumed that the current digital tools match more to the needs of men who voiced interest in their own radiation protection. There are various types of digital tools (Madanian et al., 2020), including information and communication technology, sensor or measurement devices, and artificial intelligence. The present survey focused on the KAP toward measurement devices. In contrast, women’s needs might be better served by information and communication technology, given their interest in engaging with digital tools in their daily lives.

A recent report from Japan assessing digital health literacy revealed that men exhibited higher scores in three key areas: the ability to search for information, assess its reliability and applicability, and to post messages (Miyawaki et al., 2024). Given the reported gender gap in digital education and current tool use as noted above and in our findings, more immediate attention and efforts are needed to gather women’s opinions, develop the digital tools combining different functions, taking into account gender differences in needs, and inform women about the usefulness of the digital tools for their lives. This was a secondary analysis of existing Internet data to explore the gender digital divide concerning a limited range of tools in Japan, and further in-depth research is needed with more participants in a specific community to grasp local needs. Such efforts are required in the normal environment as part of disaster preparedness. Especially in a nuclear disaster, radiation is invisible, and digital tools have a significant impact on visualizing exposure levels and improving radiation protection measures (Ohba et al., 2020).

Funding

This research did not receive any specific funding.

Conflicts of interest

The authors declare that they have no conflict of interest.

Data availability statement

The data are available from the corresponding author upon reasonable request.

Ethics approval

The study was approved by the Fukushima Medical University Ethics Committee (No. 2019-133).

Informed consent

This study did not use any data involving human subjects.

References

All Tables