Health equity in urban and rural settings: implementation of the place standard tool in Spain.

The physical, social, and economic characteristics of neighborhoods and municipalities determine the health of their residents, shaping their behaviors and choices regarding health and well-being. Addressing local environmental inequalities requires an intersectoral, participatory, and equity-focused approach. Community participation plays a vital role by providing deeper insights into local contexts, integrating community knowledge and values into processes, and promoting healthier, fairer, and more equitable actions. In recent years, various tools have been developed to assess places and transform them into health-promoting settings. One such tool, the Place Standard Tool (PST), facilitates discussions on Social Determinants of Health grouped into 14 themes, serving as a starting point for local health interventions. In this study, that took place between August 2019 and February 2020, we described the resident's perceptions of two municipalities in the Valencian Community, Spain, using the validated Spanish version of the PST. A mixed-method convergent-parallel design was used to gain a holistic insight into residents' experiences concerning their physical, economic, and social environment. A total of 356 individuals from both municipalities participated in the study through discussion groups, structured interviews, and online survey. Descriptive analysis of the individual questionnaire answers was conducted, and differences between municipalities were explored. Qualitative thematic analysis was conducted on structured interviews and discussion groups. Quantitative and qualitative data were integrated to facilitate their comparison and identify areas of convergence or divergence in the findings. Overall, rural areas received more favorable evaluations compared to urban ones. Public Transport as well as Work and Local Economy were consistently rated the lowest across all groups and contexts, while Identity and Belonging received the highest ratings. In the urban area, additional negative ratings were observed for Traffic and Parking, Housing and Community, and Care and Maintenance. Conversely, Identity and Belonging, Natural Spaces, Streets and Spaces, Social Interaction, and Services emerged as the highest-rated themes overall. In the rural context, positive evaluations were given to Walking or Cycling, Traffic and Parking, Housing and Community, and Influence and Sense of Control. Significant differences (p < 0.01) between urban and rural settings were observed in dimensions related to mobility, spaces, housing, social interaction, and identity and belonging. Our study illustrated the capacity of the PST to identifying aspects within local settings that influence health, revealing both positive and challenging factors. Successful implementation requires appropriate territorial delineation, support from local authorities, and effective management of expectations. Furthermore, the tool facilitated community participation in decision-making about local environments, promoting equity by connecting institutional processes with citizen needs.

[Entornos de Vida tool: innovation in participatory health analysis with an equity approach]. / Herramienta Entornos de Vida: innovación en el análisis participativo de salud con enfoque de equidad.

Municipal governments have the capacity to tackle the social determinants of health that play a role in their territories. The Valencian Community's local health action strategy promotes an intersectoral, participatory and equity-oriented approach to health inequalities affecting neighborhoods and municipalities across the region. To guide local health action, there is a need to adopt methodologies that capture community-based knowledge and experiences, encouraging community engagement at all stages. This article presents a methodology to carry out a local health needs assessment applying the Entornos de Vida tool. This tool enables the analysis of neighborhoods and municipalities through identifying how their characteristics have an impact on the health and well-being of their inhabitants.

Properties of the Spanish Version of the Place Standard Tool.

(1) Background: The social determinants that maintain health inequalities are organized in the physical, social, and economic contexts of neighborhoods and municipalities. Their characteristics influence the behaviors and choices of the people living in them, with an impact on their health and well-being. In recent years, several local applications and urban development tools have been designed to learn how to promote the development of health and wellness environments. Aim: The purpose was to test the properties of the Spanish adaptation of the Place Standard Tool through its implementation in a Valencian community municipality. (2) Methods: Metric properties were analyzed from a sample of 242 participants. Descriptive statistics were used to analyze the sociodemographic data and to describe item responses. Cronbach's alpha was used to provide a measure of the internal consistency, whereas the Kaiser-Meyer Olkin test was relied upon to study the relationship between different variables. (3) Results: The questionnaire showed an internal consistency index of 0.849 and a KMO of 0.842, with a single factor variance of 81.50%. (4) Conclusions: The Spanish adaptation of the Place Standard Tool is a valid tool for assessing neighborhoods and municipalities with a focus on social determinants of health and equity.

[Participatory evaluation in place-based communities: adaptating and validating the Place Standard tool to Spanish context]. / Evaluación participativa del territorio con enfoque de equidad: adaptación y validación de la Place Standard al contexto español.

OBJECTIVE: Translation and cross-cultural adaptation to the Spanish context of the Place Standard tool to undertake participatory evaluations in place-based communities. METHOD: A back-translation method was used to obtain an adapted version of the original Place Standard tool. The translated version was reviewed by a multidisciplinary committee of experts and validated using the Delphi method. RESULTS: The final version of the adapted Place Standards tool (Entornos de Vida in Spanish) consists of 14 dimensions and 99 items. 21% of the items presented semantic difficulties during the translation. Total consensus through the Delphi panel was reached on 72% of the items. The analysis resulted in changes to the wording, and organization of the items, and the inclusion of new or modified questions to reflect the characteristics of the Spanish context. CONCLUSIONS: The validation of the Entornos de Vida tool will enable the evaluation of place-based communities characteristics/physical and socio-economic contexts in a participatory and equitable manner that focuses on social determinants of health. Its application in scenarios that take into account processes of local health action will support the practice of health promotion and equity, and centre the attention and action on the physical and socio-economic contexts with the aim to learn how places and municipal policies can affect health and well-being.

[Results of 10 years of the Colorectal Cancer Prevention Program in the Valencian Community.] / Resultados de 10 años del Programa de Prevención de Cáncer Colorrectal en la Comunitat Valenciana.

OBJECTIVE: The population-based Program for the Prevention of Colorectal Cancer (PPCRC) was implemented in 2005 in the Valencian Community, following the guidelines of the European Union. To achieve the desired effectiveness in these programs, it is necessary to achieve a series of requirements, assessable through the program indicators. The objective of this study was to analyze the evolution of the program indicators from 2006 to 2016. METHODS: The accumulated indicators for the period were calculated. The Poisson regression model was used to compare the indicators by age groups and sex, by type of screening, by type of fecal occult blood test (FOBT) and by year. RESULTS: The number of people invited to participate was 1,934,266. The participation rate was 44.4%, being 87.6% in the subsequent screening and 33.7% in the initial one, with men over 60 having the lowest participation figures. Except for the positive predictive value (PPV) for low risk adenomas, which was higher in a group of men aged 50 to 59 years of successive screening, the detection rates and PPV for the different types of lesions were higher in the initial screening, with immunological test and in the group of men over 60 years old. Throughout the period, there was a decrease in the test positivity rates and in the advanced adenomas and cancers detection rates. CONCLUSIONS: The PPCCR reaches levels of quality for which the effectiveness of the program is demonstrated. However, the insufficient participation of some population groups highlights the need to carry out studies to achieve the desired objectives in all population groups and thus result in greater effectiveness of the program.

OBJETIVO: El Programa Poblacional de Preven-ción de Cáncer Colorrectal (PPCCR) se implantó en 2005 en la Comunitat Valenciana, siguiendo las directrices de la Unión Europea. Para alcanzar la efectividad deseada en estos programas es necesario conseguir una serie de requisitos, valorables mediante los indicadores del programa. El objetivo del presente estudio fue analizar la evolución de los indicadores del programa de 2006 a 2016. METODOS: Se calcularon los indicadores acumulados para el periodo. Se empleó el modelo de regresión de Poisson para comparar los indicadores por grupos de edad y sexo, por tipología de cribado, por tipo de test de sangre oculta en heces (TSOH) y por año. RESULTADOS: El número de personas invitadas a participar fue de 1.934.266. La tasa de participación fue del 44,4%, siendo del 87,6% en el cribado sucesivo y del 33,7% en el inicial, teniendo los hombres mayores de 60 años las menores cifras de participación. Excepto el valor predictivo positivo (VPP) para adenomas de bajo riesgo, que fue superior en grupo de hombres de 50 a 59 años en cribado sucesivo, las tasas de detección y VPP para los diferentes tipos de lesiones fueron mayores en el cribado inicial, con el tipo de test inmunológico y en el grupo de hombres mayores de 60 años. A lo largo del periodo se produjo un descenso en las tasas de positividad para el test y las tasas de detección de adenomas avanzados y cánceres. CONCLUSIONES: El PPCCR alcanza niveles de calidad para los que se demuestra la eficacia del programa. Sin embargo, la participación insuficiente de algunos grupos poblacionales remarca la necesidad de realizar estudios para conseguir los objetivos deseados en todos los grupos poblacionales y así redundar en una mayor eficacia del programa.

[Evaluation of a pilot program of physical activity prescription in primary care in the Valencian Community (Spain)]. / Valoración de un programa piloto de prescripción de actividad física en atención primaria en la Comunitat Valenciana.

OBJECTIVE: Assess the prescription process, adherence and impact on health measured in improvement of self-esteem and health-related quality of life, as short-term health indicators, from a pilot study of prescription of physical activity assets for 3 months. METHOD: Quasi-experimental study before-after without a control group, for the evaluation of the pilot phase (November 2017 and May 2018) of the program Conecta Actius per a la Salut in the Valencian Community (Spain). The physical activity prescription was performed and a questionnaire was completed at the beginning (T0) and at 3 months (T1). A descriptive analysis was carried out by sex and educational level where the differences between T0 and T1 were calculated using chi square and the Wilcoxon test of two dependent samples. RESULTS: The sample was 82 in T0 and 78 people in T1. The analysis shows an improvement between quality of life (7%; p ≤0.001), health perception (12,5%; p ≤0.001) and self-esteem (5,9%; p ≤0.001) between T0 and T1. The improvement proportion in Health perception is greater in women than in men for the three measured scales and in those who have a higher educational level or have been prescribed in centers that offer a single asset. CONCLUSION: Pilot study shows short-term health benefits after the physical activity prescription. Specifically, there is an improvement in the quality of life, health perception and self-esteem of the population.

[Municipalism and community health: transforming through local government. SESPAS Report 2018]. / Municipalismo y salud comunitaria: transformar desde los ayuntamientos. Informe SESPAS 2018.

Municipalities and local government are an essential element to promote public policies that improve people's health, and impact the social determinants of health, through developing approaches which incorporate equity, community engagement and intersectoral partnership at their core. The objective of this article is to analyze the barriers and opportunities that can be encountered within local governments when interventions aimed at improving people's health are developed and implemented. The evolution of the city councils, their competence frameworks and the current socio-political context are described, and three key tools for local action are proposed: intersectorality, community engagement and working in partnership with other administrations. Global strategies such as the implementation of the "community health" and "health in all policies" approach through cross-sectoral networks/partnerships are described, emphasizing the importance of developing formal and informal structures or processes of community engagement and designing local health action plans in cooperation with other administrations, such as regional and national governing bodies. To continue supporting these forms of local governance, we propose adapting the local administrations to the new social realities, with more horizontal and flexible organization models and resource allocation, integrating efficiency and evaluation processes, reclaiming local autonomy, and building local governance through networks and alliances.

Severe complications in colorectal cancer screening colonoscopies in the Valencian Community. / Complicaciones graves en las colonoscopias de cribado del cáncer colorrectal en la Comunidad Valenciana.

OBJECTIVE: To identify and characterise the severe complications of diagnostic confirmation colonoscopies carried out as part of the Colorectal Cancer Screening Program of the Valencian Community (CCSP-VC). METHOD: A retrospective observational study from 2005 to 2012. To identify complications, the CCSP-VC information system was used, as well as Spanish Minimum Basic Data Set hospital discharge summaries and medical records. Cumulative incidence rates were estimated for all complications, immediate complications (occurring the same day as the colonoscopy) and delayed complications (occurring 1-30 days after the colonoscopy) for the 1,000 colonoscopies performed. A bivariate analysis using the Chi-square test was performed for the onset of complications, according to gender, age and type of test (guaiac/immunological), as well as for the complication onset time (immediate/delayed) based on the type of colonoscopy (diagnostic/therapeutic) and type of complication (haemorrhage/perforation). RESULTS: Of the total 8,831 screening colonoscopies performed, 23 severe complications were observed, 13 of which were perforations (56.5%) and 10 haemorrhages (43.5%). No serious vagal syndrome, peritonitis or deaths were recorded. The cumulative incidence rate was 2.60‰; 2.85‰ for the guaiac test and 2.56‰ for the immunological test. The incidence rate was higher in men (2.93‰) than in women (2.16‰), as well as in older groups (3.02‰ versus 1.98‰). Of the total complications, 61% (n=14) were immediate. CONCLUSIONS: The severe complication rates of screening colonoscopies are a quality indicator for population-based colorectal cancer screening programs that require extensive research in order to maintain the appropriate risk/benefit ratio of such programs.