Spezia Nicola, De Rosis Sabina, Nuti Sabina
Interdisciplinary Research Center "Health Science", Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, Pisa, 56127, Italy.
Institute of Management and Department of Excellence L'EMbeDS, Management and Healthcare Laboratory, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, Pisa, 56127, Italy.
BMC Health Serv Res. 2025 May 19;25(1):716. doi: 10.1186/s12913-025-12817-3.
Rural areas face unique and interconnected challenges that hinder both access to and quality of health and social services. In response, local communities are increasingly called to proactively engage in identifying their own needs and developing solutions. Sense of Community (SoC) has emerged as a key element in building community capacity and resilience, as well as a crucial protective factor for individual health and well-being. However, the influence of SoC on citizens' perceived service quality remains underexplored. This investigation can provide additional evidence on how SoC reflects the social resources that can be leveraged to address common challenges. To this end, this study examines the relationship between SoC and citizens' perceived quality of health and social services in rural areas.
Survey data from 405 citizens who participated in a "Population Experience Observatory" within a community-based participatory research in the rural Serchio Valley of Tuscany, Italy, were used. SoC was measured using an 8-item scale, while perceived quality was assessed through two evaluation ratings-one for health services and one for social services. Ordered logistic regressions were conducted to examine the factors influencing SoC and the relationship between SoC and service evaluations, adjusting for other individual-level and health-related factors.
Higher SoC was significantly associated with more positive evaluations of both health and social services (AOR: 1.49, 95% CI: 1.32-1.69, p < 0.001, and AOR: 1.57, 95% CI: 1.33-1.77, p < 0.001, respectively). Significant factors positively correlated with SoC included older age, better self-reported health, and receiving help from third-sector organizations. Also being a member of these organizations and being raised in the area were positive predictors of SoC but negatively associated with service evaluations.
This study underscored a significant positive relationship between SoC and perceived service quality. As traditional approaches become less viable due to escalating demands and limited resources, SoC could be a valuable asset for local communities in taking more responsibility for their own health. SoC could be central in shaping a new season of rural health and social care policies aimed at ensuring the sustainable delivery of services. Such policies should emphasize the proactive engagement of local communities and the shift in professional roles from sole providers to advocates and enablers of these empowered communities.
农村地区面临着独特且相互关联的挑战，这些挑战阻碍了人们获得卫生和社会服务，也影响了服务质量。对此，当地社区越来越被要求积极参与确定自身需求并制定解决方案。社区意识已成为建设社区能力和恢复力的关键要素，也是影响个人健康和福祉的重要保护因素。然而，社区意识对公民感知服务质量的影响仍未得到充分研究。这项调查可以提供更多证据，说明社区意识如何反映可用于应对共同挑战的社会资源。为此，本研究考察了农村地区社区意识与公民对卫生和社会服务的感知质量之间的关系。
使用了来自405名公民的调查数据，这些公民参与了意大利托斯卡纳塞尔基奥山谷农村地区一项基于社区参与式研究中的“人口体验观察站”项目。社区意识采用一个包含8个条目的量表进行测量，而感知质量则通过两项评估评分来评估，一项针对卫生服务，另一项针对社会服务。进行有序逻辑回归分析以考察影响社区意识的因素以及社区意识与服务评估之间的关系，并对其他个体层面和健康相关因素进行了调整。
较高的社区意识与对卫生和社会服务更积极的评价显著相关（卫生服务的调整后比值比[AOR]为1.49，95%置信区间[CI]为1.32 - 1.69，p < 0.001；社会服务的AOR为1.57，95% CI为1.33 - 1.77，p < 0.001）。与社区意识呈正相关的显著因素包括年龄较大、自我报告的健康状况较好以及接受第三部门组织的帮助。成为这些组织的成员以及在该地区长大也是社区意识的积极预测因素，但与服务评估呈负相关。
本研究强调社区意识与感知服务质量之间存在显著的正相关关系。由于需求不断增加和资源有限，传统方法的可行性降低，社区意识可能成为当地社区对自身健康承担更多责任的宝贵资产。社区意识可能是塑造农村卫生和社会护理新政策季的核心，这些政策旨在确保服务的可持续提供。此类政策应强调当地社区的积极参与，以及专业角色从唯一提供者向这些赋权社区的倡导者和促进者的转变。
