Generating Contextual Variables From Web-Based Data for Health Research: Tutorial on Web Scraping, Text Mining, and Spatial Overlay Analysis.

BACKGROUND: Contextual variables that capture the characteristics of delimited geographic or jurisdictional areas are vital for health and social research. However, obtaining data sets with contextual-level data can be challenging in the absence of monitoring systems or public census data. OBJECTIVE: We describe and implement an 8-step method that combines web scraping, text mining, and spatial overlay analysis (WeTMS) to transform extensive text data from government websites into analyzable data sets containing contextual data for jurisdictional areas. METHODS: This tutorial describes the method and provides resources for its application by health and social researchers. We used this method to create data sets of health assets aimed at enhancing older adults' social connections (eg, activities and resources such as walking groups and senior clubs) across the 374 health jurisdictions in Catalonia from 2015 to 2022. These assets are registered on a web-based government platform by local stakeholders from various health and nonhealth organizations as part of a national public health program. Steps 1 to 3 involved defining the variables of interest, identifying data sources, and using Python to extract information from 50,000 websites linked to the platform. Steps 4 to 6 comprised preprocessing the scraped text, defining new variables to classify health assets based on social connection constructs, analyzing word frequencies in titles and descriptions of the assets, creating topic-specific dictionaries, implementing a rule-based classifier in R, and verifying the results. Steps 7 and 8 integrate the spatial overlay analysis to determine the geographic location of each asset. We conducted a descriptive analysis of the data sets to report the characteristics of the assets identified and the patterns of asset registrations across areas. RESULTS: We identified and extracted data from 17,305 websites describing health assets. The titles and descriptions of the activities and resources contained 12,560 and 7301 unique words, respectively. After applying our classifier and spatial analysis algorithm, we generated 2 data sets containing 9546 health assets (5022 activities and 4524 resources) with the potential to enhance social connections among older adults. Stakeholders from 318 health jurisdictions registered identified assets on the platform between July 2015 and December 2022. The agreement rate between the classification algorithm and verified data sets ranged from 62.02% to 99.47% across variables. Leisure and skill development activities were the most prevalent (1844/5022, 36.72%). Leisure and cultural associations, such as social clubs for older adults, were the most common resources (878/4524, 19.41%). Health asset registration varied across areas, ranging between 0 and 263 activities and 0 and 265 resources. CONCLUSIONS: The sequential use of WeTMS offers a robust method for generating data sets containing contextual-level variables from internet text data. This study can guide health and social researchers in efficiently generating ready-to-analyze data sets containing contextual variables.

[The role of the nurse in the field of public health]. / El rol de la enfermería en el ámbito de la salud pública.

OBJECTIVE: Identify the role of public health nurses and differentiate it from that of community care nurses in the context of Catalonia, through the experiences and perspectives of professionals in the field of public health. METHOD: Descriptive phenomenological qualitative study. Fourteen interviews were conducted with key informants, from the field of public health and community care, selected by i purposive sampling. Content analysis using thematic methodology, creation of categories from the triangulation of results. RESULTS: The professional competencies and functions performed by nursing in the field of public health are analysed. Most of the specific functions were the ones related to "care" and the "global vision" of health. The indeterminacy of functions and roles, related to gender inequality, leads to a low recognition of the profession and a lack of appropriateness of the professional category, reflected in a low presence of nurses in management positions in public health. Although some competencies are shared with the family and community nurse, there are also differences. CONCLUSIONS: This study sheds light on the role of public health nursing, often overlooked. It is urgent to define public health nurses role and functions, in order to avoid inequalities and increase their recognition.

Daily sitting time and its association with non-communicable diseases and multimorbidity in Catalonia.

BACKGROUND: Non-communicable diseases (NCDs) account for 71% of deaths worldwide and individual behaviours such as sedentariness play an important role on their development and management. However, the detrimental effect of daily sitting on multiple NCDs has rarely been studied. This study sought (i) to investigate the association between sitting time and main NCDs and multimorbidity in the population of Catalonia and (ii) to explore the effect of physical activity as a modifier of the associations between sitting time and health outcomes. METHODS: Cross-sectional data from the 2016 National Health Survey of Catalonia were analyzed, and multivariable logistic regression, adjusting for socio-demographics and individual risk factors (tobacco and alcohol consumption, diet, hyperlipidaemia, hypertension, body mass index) was used to estimated odds ratios (ORs) and 95% confidence intervals (CIs) of the association between sitting time and NCDs. RESULTS: A total of 3320 people ≥15 years old were included in the study. Sitting more than 5 h/day was associated with a higher risk of cardiovascular disease (OR 1.90, 95% CI: 1.21-2.97), respiratory disease (OR 1.61, 95% CI: 1.13-2.30) and multimorbidity (OR 2.80, 95% CI: 1.53-5.15). Sitting more than 3 h/day was also associated with a higher risk of multimorbidity (OR 2.26, 95% CI: 1.23-4.16). Physical activity did not modify the associations between sitting time and any of the outcomes. CONCLUSIONS: Daily sitting time might be an independent risk factor for some NCDs, such as cardiovascular disease, respiratory disease and multimorbidity, independently of the level risk of physical inactivity.

Evaluation of the Catalan Physical Activity, Sports and Health Plan: a nested case-control study.

BACKGROUND: Physical inactivity is one of the most important risk factors in modern society. Primary Health Care (PHC) interventions have been shown to be effective to increase physical activity (PA). This work evaluates the Catalan Physical Activity, Sport and Health Plan (PAFES). METHODS: Nested case-control design with risk-set matching based on a retrospective cohort of 22 450 physically inactive people registered between 2010 and 2018 in the Catalan electronic medical record (EMR). Confounder adjusted conditional logistic regression was used to estimate the probability that participants who had received PA advice became active between 2010 and 2018 compared to those who did not receive it. RESULTS: A lower probability to become active [odds ratio (OR) = 0.11, 95% confidence interval (CI) 0.10-0.13] was found for those people who had received PA advice only once. However, the probability to become active increased for people who had received advice two or more times (two times: OR = 1.43, 95% CI 1.32-1.55). A dose-response relationship was observed. CONCLUSIONS: This is the first study evaluating a PA promotion real-life intervention in PHC using a large cohort based on data from an EMR with more than 2 years of follow-up.

Health Impact Assessment (HIA) of a fluvial environment recovery project in a medium-sized Spanish town.

INTRODUCTION: The Interdepartamental Public Health Plan of Catalonia (2014) seeks to enforce Health in All Policies (HiAP) at the regional and local levels. Within this context, the City Council of Sant Andreu de la Barca (SAB), the Metropolitan Area of Barcelona (MAB), and the Public Health Agency of Catalonia started a Health Impact Assessment (HIA) of an urbanistic redesign of the Llobregat fluvial area in SAB, the results of which are presented in this paper. METHODOLOGY: In 2018, after a HIA screening, a prospective nonquantitative HIA was conducted. Politicians, professionals, and citizens participated in identifying potential impacts. Impacts were prioritized and linked to health determinants, scientific evidence, and potentially affected social groups. Afterwards, recommendations were formulated in order to improve the health impacts of the project. Finally, indicators were selected to evaluate HIA implementation. RESULTS: The HIA was successfully implemented with the participation of technicians and citizens of SAB. The health impacts identified were mainly related to environmental, public safety, lifestyle, socioeconomic, and political contexts. Ten recommendations were defined to minimize the potential negative health impacts of the project, with six of them directly included and only one dismissed due to incompatibility. CONCLUSION: A HIA was successfully carried out in the medium-sized town of Catalonia, promoting Health in all Policies at a local level and improving health impacts of an urbanistic project.

[Facilitating community oriented primary health care. Basic health indicators by small areas in Catalonia]. / Facilitando la salud comunitaria. Indicadores básicos de salud por área básica de salud en Cataluña.

Health depends mostly on factors that lay outside the health system, such as socioeconomic determinants. Intersectorality and participation are key elements for an integrated care person and community centred. In Catalonia, the National Primary Health and Community Strategy aims to reinforce primary health care, so that it becomes the backbone of the health system and with a strong community orientation. To deploy a community oriented primary health care it is important to count with reliable and robust data by small areas. Thirty-eight basic indicators were selected for each of the 370 primary health care in Catalonia. Indicators were calculated and presented following the social determinants model: demographic (4), socioeconomic (3), morbidity (9), mortality (6), lifestyles (4), preventive practices (1), resources and use of health services (9) and physical environment (2). These indicators will allow health professionals to carry out local health assessments in a fast and systematic manner.

[Implementation of the World Physical Activity Day in Catalonia]. / Implementación del día mundial de la actividad física en Cataluña.

OBJECTIVE: Even though physical activity (PA) has multiple benefits, 30% of the population is inacti- ve. Catalonia impulse the World Physical Activity Day (WPAD), as a part of a broader strategy of PA promotion. The objetive of this work was to present the implementation and evolution of WPAD from 2010 to 2016. METHODS: Repeated cross-sectional study. WPAD celebration was promoted through the web www.pafes. cat, a registry form, and a communication plan. Studied variables were: n. of entities, events (type) and participants, % of coordinated events, number of web visits and cost. A descriptive univariate analysis and calculation of frequencies was done. RESULTS: Spreading was done to >9000 electronic addresses per year. Between 2010 and 2016 organizing entities, events and participants (2,8% of population in 2016) multiplied by 5. Organized events (walks, supervised PA, sport and diffusion) were done in coordination and mobilized 25 to 500 people, from a variety of settings. Estimated mean cost was 1 cent of euro by participant. CONCLUSIONS: WPAD managed to reach an important amount of population at a minimum cost.

OBJETIVO: Aunque la práctica de actividad física (AF) tiene múltiples beneficios, el 30% de personas son inactivas. Cataluña impulsó el Día Mundial de la actividad física (DMAF) como parte de una estrategia más amplia de promoción de la AF. Este trabajo tuvo como objetivo presentar la implementación y evolución 2010-2016. METODOS: Estudio transversal de tendencias. Se impulsó la celebración del DMAF mediante la web www. pafes.cat, un formulario de registro y un plan de comunicación. Las variables estudiadas fueron número de entidades, tipos de eventos y participantes, el porcentaje de eventos coordinados, el número de visitas web y el coste. Se realizó un análisis descriptivo univariado y de frecuencias. RESULTADOS: Se realizó la difusión a >9000 direcciones electrónicas/año. Entre 2010 y 2016 se multiplicaron por cinco las entidades organizadoras, eventos y participantes (en 2016 2,8% de la población), durante marzo y abril aumentaron las visitas a la web. Los eventos (caminatas, AF dirigida, deporte y difusión) presentaron coordinación y movilizaron de 25 a 500 personas desde diversos ámbitos. El coste estimado medio fue de 1 céntimo por participante. CONCLUSIONES: El DMAF consiguió llegar a un gran volumen de población con un coste mínimo.

Promoting physical activity through primary health care: the case of Catalonia.

BACKGROUND: In adults, as little as 10 minutes of moderate physical activity (PA) three times a day can help prevent non-communicable diseases and prolong life expectancy. The aim of the study was to evaluate the process and impact of scaling up a complex intervention (PAFES) implemented in Catalonia, aimed to increase the proportion of adults complying with PA recommendations (especially those with cardiovascular risk factors). METHODS: The intervention, piloted in 2005, had three elements: 1) establishing clinical guidelines for PA; 2) identifying local PA resources; 3) PA screening and advice in primary health care (PHC) settings, based on stage of change. Central and local level implementation activities included training, support to municipalities, dissemination through a web page, and promotion of World Physical Activity Day (WPAD). Evaluation followed the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance), identifying 3-6 variables for annual evaluation of each dimension. These included coverage of PA screening and advice and individuals with access to a healthy exercise route (Reach), increased PA level between 2006 and 2010-15 (Effectiveness), PAFES adoption by PHC centres and municipalities (Adoption), process evaluation data (Implementation), and cost (Maintenance). RESULTS: PHC screening coverage increased from 14.4% (2008) to 69.6% (2015) and advice coverage from 8.3% (2012) to 35.6% (2015). In 2015, 82.5% patients had access to a "healthy route" (Reach). The proportion of patients with at least one cardiovascular risk factor who were "sufficiently active" increased from 2006 to 2010-2013 (Effectiveness). By 2015, PAFES was applied by all PHC teams, 8.3% municipalities and 22.7% PHC centres had organized WPAD events (Adoption). The Plan showed good penetration in all health regions by 2013, with relatively low use of resources and estimated cost (Implementation). By 2013 the Plan was embedded within the health system (Maintenance). CONCLUSIONS: In the first application of the RE-AIM framework to evaluate the scaling-up of a PA plan, PAFES showed good results for most RE-AIM indicators. Changes in priority and investment in health promotion programs affect reach, adoption, and effectiveness. It is important to maintain support until programs are strongly embedded into the health system.