Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.