Care-Based Collaboration for Regional Sustainability: A Constructivist Grounded Theory Study of Community Nurses and Local Businesses in Japan

Introduction: Japan’s rapidly aging and depopulating regions face growing challenges in sustaining healthcare, social welfare, and local economies. Community nurses (CNs) have emerged as key actors bridging healthcare, community life, and, more recently, local businesses. However, the processes through which collaboration between CNs and corporations becomes meaningful, operational, and sustainable remain insufficiently theorized. This study explores how CN-corporate collaboration is constructed and how it contributes to regional sustainability beyond short-term economic outcomes. Methods: A constructivist grounded theory approach was employed. Semistructured interviews were conducted with three senior corporate leaders engaged in formal collaboration with CNs. In parallel, practice-based records, activity narratives, and reflective notes produced by CNs working in small teams within each collaboration were analyzed. Data collection and analysis proceeded iteratively using line-by-line coding, focused coding, constant comparison, memo writing, and dialogic refinement between researchers. Results: Three interrelated theories were generated. First, corporate engagement emerged from dissatisfaction with reactive, after-the-fact support systems and a reframing of corporate responsibility as inseparable from community survivability. Second, CNs functioned as an implementation-oriented relational infrastructure by receiving delegated implementation authority and mediating across corporate, community, and care systems. Third, collaboration led to a reconstitution of value and sustainability through relational outcomes, including increased resident agency, relational continuity, and community vitality, rather than cost reduction alone. Conclusion: Collaboration between CNs and local businesses becomes sustainable when care-based, relational practices are delegated, enacted, and valued as investments in community continuity. CNs play a critical role as relational implementation infrastructure, translating preventive care into operational reality and supporting long-term regional and corporate sustainability in aging societies.