The Support Paradox in Japanese High Schools: Barriers to Credit Recognition for Third-party On-Demand Learning in Students with Chronic Illness

Ensuring educational rights for students with chronic illnesses is a critical challenge globally. While technology-enhanced distance education, particularly on-demand learning, offers promising solutions, implementation faces numerous barriers. Despite Japan’s GIGA School Program establishing digital infrastructure, adoption remains limited, necessitating urgent investigation of current conditions and challenges. This study conducted the first prefecture-wide survey of 88 high schools in Okayama Prefecture from November 2024 to January 2025 using telephone, email, and online questionnaires to assess student enrollment in long-term medical treatment, online class implementation status, implementation challenges, and acceptability of third-party educational content for academic credit. The results showed that 12.5% of the schools enrolled students requiring long-term medical treatment, with 11.4% having a history of such treatment. While 50.0% implemented only synchronous online classes, 25.0% offered on-demand formats, and 25.0% did not. Among the 60 schools that reported barriers to on-demand provision, the most frequently cited were difficulty accommodating practical/skills-based subjects (61.7%), insufficient human resources (60.0%), inadequate equipment or cloud infrastructure (41.7%), and internal regulations (11.7%). Notably, schools reporting internal barriers were far less likely to accept third-party on-demand modules for credit than those reporting no barriers (20.0% vs. 50.0%; Fisher’s exact p=0.0059; OR=0.25). More than a year after national guidance enabled credit recognition for on-demand learning, implementation remains limited, largely due to staffing constraints and subject-specific hurdles. To secure learning opportunities for students with chronic illnesses, education boards should establish clear evaluation criteria, governance, and quality-assurance frameworks for external resources that move beyond school-by-school efforts.