Unhealthy lifestyles, environment, well-being and health capability in rural neighbourhoods: a community-based cross-sectional study – BMC Public Health

Study area, design and community setting

The cross-sectional analyze was conducted in 15 rural neighbourhoods from six municipalities in the Centre region of Portugal ( Fig. 1 ), aiming at 1 ) assessing evidence-based data and describing lifestyles, 2 ) examining determinants of health and wellbeing in rural neighbourhoods, and 3 ) discuss how individuals ’ conditions and population ’ circumstances can contribute with a better understand to improve health capability in rural neighbourhoods .Fig. 1 location of rural neighbourhoods ; basemap is provided by ESRI, available as function of the map platform ArcGIS Online Full size visualize The selection of the rural neighbourhoods of the “ Terras de Sicó ” ( Lands of Sicó ) network ( Sicó-network ) was drawn on a CBPR access. Given potential differences at the administrative tied, which could influence local practices, we considered the three relevant levels of territory administrative structure : small villages, parish councils, and municipalities seats ( hereinafter referred as municipality ) ( Fig. 1 ). According to the Portuguese National Statistics Institute, in 2011, 3879 individuals were living in the 15 rural neighbourhoods ( postpone 1 ), one third gear of the population was older than 64 years and with a high gear rate of limited literacy ( e.g., the proportion of individuals that do not know how to read is about the like as individuals with higher education ) ; which are park characteristics in portuguese rural areas [ 24 ].

Table 1 Demographic and social characteristics of the individuals by neighbourhoods’ type Full size table The study encompasses a qualitatively drive mixed-method design, that is, simultaneously, qualitative ( QUAL ; inductive theoretical repel ) and quantitative ( quan ) : QUAL+quan [ 25 ] : quan to describe and examine individuals ’ health functioning condition ( evidence-based data and lifestyles ) ; QUAL to document how individuals experience their vicinity in terms of health and wellbeing [ 26 ], and to better understand which local circumstances influence the ability to adopt healthier lifestyles and to pursue health [ 18 ]. Our CBPR approach involved the local representatives from the Sicó-network ( n = 20 ; among policymakers, local anesthetic residential district members and stakeholders ) ; boost train students and young professionals ( n = 13 ), from biomedical sciences, medicate and sports sciences ; a trans-disciplinary inquiry and invention team ( n = 18 ) involving researchers from life sciences, aesculapian and health sciences, and social sciences, and developers of promote engineering for health monitoring and e-health services, including two international members of the HeaLIQs consortium and two members of the consortium Ageing @ Coimbra. Two local consolidation meetings with local representatives of the Terras de Sicó network and the inquiry and initiation team, held in two municipalities, Penela ( May 28, 2019 ) and Alvaiázere ( June 11, 2019 ), created the bases of the CBPR approach, and a roadmap for local anesthetic itineraries and local community engagement. triangulation between local anesthetic representatives and researchers regarding the CBPR approach contributed to : better characterizing the demography in the 15 neighbourhoods ; co-designing the residential district program adapted to each vicinity ; co-constructing a health communication scheme and tailored healthy lifestyles-related messages for older adults with limit literacy ; discussing the theoretical background [ 14, 15, 16, 17, 18, 19, 20 ] and the QUAL+quan methodology connecting with a questionnaire [ 27 ] incorporated in preexistent eVida engineering [ 28 ] ; and training volunteer students and young professionals to operationalize translational inquiry and participatory approaches with community betrothal in neighbourhoods. local representatives collaborated actively in the dissemination of the program via national/regional media ( i.e., newspapers, radio, television receiver and flyers ), social media ( i.e., Facebook ) and institutional websites ( for example, Sicó-network, municipalities, local stakeholders and university ). Overall, the purpose took about 9 months, from January to September 2019 .

Mobile healthy living room

The community program took station in a fluid Healthy Living Room ( mHLR ) ( Fig. 2 ), designed as a mobile community serve, to reach isolated rural neighbourhoods with lower entree to health care facilities and awareness about healthy lifestyles. The mHLR was equipped with a healthy life style assessment toolkit, which comprises medical devices and a questionnaire [ 27 ] incorporated in eVida engineering. eVida is a tablet-based lotion centred on the input signal of the questionnaires ( as discussed in detail below ), provides a personalize summary of putative health risks associated with individual characteristics and behaviours [ 28 ] .Fig. 2 Community program intervention design ; credits : the research team Full size persona The community interposition involved 1 ) the judgment of evidence-based data ( for example, BMI, shank circumference, and self-assessment of illnesses or chronic diseases, medicine and sleep habits ), 2 ) life style portrayal ( for example, diet, active lifestyles, quality of life and self-assessment of health and wellbeing ), 3 ) demographic information ( i, arouse, age, use status and horizontal surface of education ), complemented with 4 ) the self-assessment of vicinity satisfaction, all incorporated in eVida engineering, and 5 ) the individual in-depth interview about the context in locate to pursue dependable health in the vicinity. Each player was accompanied by a trail team member and community intervention included two to four team members and four to six students/young professionals, depending on the neighbourhoods ’ population.

At the end, participants received the results of the eVida questionnaire and prevention recommendations in an personalize report vitamin a well as short-circuit cartoon-like active agent healthy lifestyles messages, about diet, physical natural process, social coherence, and mental health and wellbeing. This research was partially of a collaborative european inquiry project, Healthy Lifestyle Innovation Quarters for Cities and Citizens ( HeaLIQs4Cities ), funded by the European Institute of Innovation and Technology for Health ( EIT Health ), that unite researchers and neighbourhoods from Coimbra ( Portugal ), Groningen ( The Netherlands ) and Copenhagen ( Denmark ), around the concept of health capability and drivers of health and wellbeing. Among the stakeholders, the consortium Ageing @ Coimbra represents a character site in Centro region of Portugal within the European Innovation Partnership ( EIP ) on Active and Healthy Ageing ( AHA ), that is founded on a quartet helix-based initiation model for improving active and healthy aging in Europe [ 28 ] .

Data collection

One proportion of the data aimed at collecting evidence-based data, lifestyles and self-assessment of neighborhood satisfaction incorporated in eVida, as mentioned above, while another dimension of the data aspired at documenting the context in place influencing the ability to pursue health and wellbeing in the vicinity. The weight and shank circumference were measured and BMI assessed ; the factors associated with illnesses or chronic diseases, medicine, and sleep habits were self-reported. The quality of biography followed EQ-5D-5L questionnaire : mobility, self-care, usual activities, pain/discomfort and anxiety/depression ( each dimension is rated on scale with 5 levels : no problems, little problems, chasten problems, severe problems and extreme problems ). We besides considered two extra dimensions of self-assessment of health and wellbeing of ‘ quality of life ’ ( with 5 levels, powerfully disagree, disagree, neither agree nor disagree, agree, strongly agree ) and ‘ health discipline ’ ( with 5 levels, very good, good, fair, badly, very bad ). Regarding the description of lifestyles, diet was categorized per food groups per day and per workweek ( following 5 levels in the Likert plate ). qualitative research advances the possibilities of a deeper understand of people ’ south perceptions and expectations and exploring singular topics within the research aims. For that determination, we conducted the open-ended question in an in-depth interview : “ What would you change in your neighbourhood to have a healthier life? ”. To reduce eventual sex appeal diagonal, participants were ensured prior the eVida questionnaire that were no correct or amiss responses and a privacy environment was ensured during the consultation ; the eVida and interview took in between 45 to 60 min. Through eVida, data was collected on a random sample of 270 individuals living in rural neighbourhoods from the Sicó-network, considering the dimension and location of the neighborhood ( small villages, parish council and municipalities ), constituting a sample with a gross profit of error of 5.75 % and confidence level of 95 %. The sample size for the interviews was determined by applying the saturation period criteria, and was stopped after 107 testimonials were collected. This learn design was considered the most appropriate way to describe individuals ’ lifestyles and communities ’ environments. The collection of QUAL+quan data was performed by researchers with background on life sciences, medical and health sciences, and sociable sciences ; the CBPR approach from the very early stages revealed to be determinant for the research methodology and outcomes. furthermore, the first day of treatment was followed by a preliminary assessment and discussion by the advanced prepare students ( and young professionals ) and the team, in order to identify personal bias, optimize the use of eVida and the interview, and minimize any early form of unintended compulsion with participants. Data collection was conducted between September 4 and 23, 2019 .

Ethical considerations

This discipline was approved by the Ethics Committee of the Centre Regional Health Administration of Portugal : address 91/2019. Participants were required to be 18 years or older and were asked to sign a written inform consent before initiating the community interposition. At the end, participants received a bag with the personalize report and the short cartoon-like active healthy lifestyles messages, about diet, forcible activeness, social coherence, and mental health and wellbeing .

Data analysis

Testimonies were documented in write, and then transcribed and translated to English. Each player was linked the senesce, arouse and municipality council in orderliness to present direct quotations ( for example, Female, 68, Small Village, Pombalinho 610 ). The foremost four authors performed an independent psychoanalysis in all testimonies developing a parallel codification on drivers of health and wellbeing at residential district level in the rural neighbourhoods. After several collective discussions rounds ( over a period of 3 months ), seven consensual dimensions were identified a priori : economic development, built environment, sociable network, health worry, demography, active voice lifestyles and mobility. The a priori themes were used to code the qualitative data in which subtopics were built upon [ 29 ].

All testimonies were imported to MAXQDA Analytics Pro 2020 version 20.0.0 ( Berlin, Germany : VERBI Software GmbH ) for coding and psychoanalysis. The code was done in three stages. In the first stage, the testimonies were coded based on the selected dimensions. In a second stage of gull, the resulting identification of sub-topics for each of the 7 dimensions based on mention frequency, and the identification of overriding topics, in both individual accounts and different neighbourhoods, was carried out independently across researchers. Any new codes were consensually debated during even team meetings. In the third stage, all testimonies were coded once more by applying the final tease schema. All code testimonies were evaluated for emerging topics. We used several strategies to ensure quality in data coding. The typography of coding couple was changed after 10 to 15 testimonies to reduce possible taxonomic bias. Using this approach, we were able to examine the in situ community needs in the 15 rural neighbourhoods. We besides documented the clear individual incontrovertible perceptions of live in rural neighbourhoods : iodine ) in terms of healthy living and wellbeing ; two ) the different ways of trace and explaining lifestyles and day by day habits ; three ) the multiples ways of exist and be engaged with community environment ; four ) access to health manage and health services. Authors involved in the analyses maintained the explanatory function of the CBPR process from the inquiry goals to data collection and analysis. The number and the frequency of subjects mentioned by participants in different topics support the dependability and credibility of our findings. We besides used the lexical search on the MAXQDA program for key codes, to identify the frequency and total of mentions for consistency in participants ’ responses. To supplement the qualitative analysis, binomial logistic regression models were applied : BMI ( classified in two categories : 1. corpulence and fleshiness and 2. normal and low weight ), shank circumference ( classified in two categories : 1. and 2. ), self-assessed health status ( classified in two categories : 1. good and very good and 2. less than full ), were assessed as dependent variables and sexual activity, senesce ( continuous ), place of mansion ( classified in the three classes : 1. small villages, 2. parish councils and 3. municipalities ), as independent .