Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 19;25(1):716.
doi: 10.1186/s12913-025-12817-3.

The relationship between Sense of Community and perceived service quality: rethinking the role of local communities in sustaining rural health and social care

Nicola Spezia  1 , Sabina De Rosis  2 , Sabina Nuti  3
Affiliations

The relationship between Sense of Community and perceived service quality: rethinking the role of local communities in sustaining rural health and social care

Nicola Spezia et al. BMC Health Serv Res. .

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.

Keywords: Citizen; Community building; Community capacity; Community-centred; Remote; Rural; Sense of Community; Service evaluation; Service quality.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was conducted in line with the ethical standards of the Declaration of Helsinki. Formal ethics approval was not required for the survey, in accordance with the national guidelines set by the Italian Data Protection Authority (Guidelines on Processing Personal Data for Customer Satisfaction Surveys in the Healthcare Sector, https://www.garanteprivacy.it/home/docweb/-/docweb-display/docweb/3853781 ), as well as the assessment of the Data Protection Officer at the researchers’ university. All participants provided informed consent to participate in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Relationship between SoC and health and well-being across individual and collective levels
Fig. 2
Fig. 2
Frequency distributions for SoC and evaluation of health and social services (N = 405)
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. OECD. The New Rural Paradigm: Policies and Governance, Governance An International Journal Of Policy And Administration. OECD Rural Policy Reviews. 2006;168. Available from: http://www.oecd-ilibrary.org/governance/the-new-rural-paradigm_978926402....
    1. Stut M, Alessandrini A, Deuster C, Batista E, Silva F, Natale F, Dijkstra L. Outlook and demographic perspectives for EU ’ s rural regions A modelling-based exercise. 2025. Available from: https://publications.jrc.ec.europa.eu/repository/handle/JRC140514.
    1. OECD. Rural Well-being: geography of opportunities country note. Paris; 2020. 10.1787/region-data-e. 10.1787/d25cef80-en. - DOI
    1. OECD. Strategies to Improve Rural Service Delivery. OECD Rural Policy Reviews. 2010. 10.1787/9789264083967-en.
    1. Ehrlich D, Kemper T, Uhl JH, Rivero Mari I, Florio P, Pesaresi M, et al. Atlas of the human planet 2024. Luxembourg: Publications Office of the European Union; 2024. 10.2760/855738.