Community-Based Participatory Research to Promote Social Inclusion in a Rural Town in Japan: Process Evaluation of a Pre-COVID-19 Collaboration Among Residents and Professionals.

Background: Rural communities face aging, depopulation, shrinking resources, and increasing social isolation. This study examined how a Community-Based Participatory Research (CBPR) partnership was formed and negotiated in rural Japan, focusing on collaborative decision-making and arts-based engagement as a foundation for social inclusion. Methods: A qualitative descriptive study was conducted in Nagi Town, Okayama Prefecture, Japan. Between February 2018 and January 2020, eight CBPR meetings were held with 13 participants, including family physicians, public health nurses, community-based participants, and theater professionals. Audio-recorded discussions, field notes, and documents were analyzed thematically using Braun and Clarke's framework, focusing on partnership formation, equality and representation, arts-based knowledge generation, decision-making, and implementation challenges during the pre-action phase. Results: Four cross-cutting themes were identified: equality and mutual learning, discovery of hidden community strengths, arts as a bridge for dialogue and participation, and fragility and resilience of collaborative action planning. Collaboration evolved from facilitator-led learning to shared local interpretation and distributed action planning. Two working groups explored ways to identify socially isolated residents and designed art- and memory-based events. The " Conclusions: CBPR combined with arts-based engagement may support relationship-building, shared reflection, and collaborative planning in rural communities. Rather than demonstrating intervention effectiveness, this study highlights preparatory processes as a foundation for future social inclusion efforts.