Anastasia Zissi

Background/Objectives: Assessing population healthcare needs is essential for effective primary health care (PHC) planning; however, existing approaches often rely on biomedical or service-centered frameworks (i.e., approaches focusing on utilization patterns, clinical indicators, and provider performance metrics) that may not adequately capture the multidimensional and context-dependent nature of health needs. This study aimed to develop and validate the Primary Care Needs Assessment (PCNA) questionnaire, a participatory, multidimensional, and context-sensitive instrument for assessing perceived unmet healthcare needs and contextual determinants of health in community-based PHC settings. Methods: A sequential mixed-methods design was employed. In the qualitative phase, focus groups with PHC professionals and semi-structured interviews with community members informed item generation. The resulting questionnaire was administered to a sample of 817 participants recruited from community and primary care settings. Exploratory factor analysis (EFA) was conducted on a subsample (n = 520), followed by confirmatory factor analysis (CFA) on an independent subsample (n = 297). Internal consistency was assessed using Cronbach’s alpha. Results: EFA identified a 10-factor structure explaining 55.05% of the variance. CFA supported a refined 9-factor model with good fit indices (χ²/df = 1.675, RMSEA = 0.048, CFI = 0.92, TLI = 0.90, SRMR = 0.06). The instrument demonstrated satisfactory internal consistency (α = 0.76). Findings also highlighted unmet needs related to mental health, access to specialized services, and structural barriers (e.g., geographic distance, financial cost, limited service availability, and organizational constraints in accessing care), underscoring the multidimensional nature of health needs. Conclusions: The PCNA is a valid and reliable instrument that captures the complex interplay of individual, social, and contextual factors shaping health needs in PHC. By integrating community perspectives with psychometric validation, it provides a practical tool for supporting evidence-informed planning and more responsive, person-centered PHC systems (i.e., systems that adapt service provision to community-identified priorities and evolving population needs).

Background: This study draws on old and well-established evidence that economic change, and especially recession, affects people’s lives, behavior and mental health. Even though the literature is rich on the relationship between unemployment and mental distress, there is a renewed research interest on the link between socio-economic inequalities and psychological health. Aims: The study investigates the relationship of social class with mental distress during the hard times of persistent and severe economic crisis in Greece by conducting a comparative, community study in the country’s second largest city, Thessaloniki. Method: A face-to-face structured interview covering living conditions, life events, chronic stressors and coping strategies was employed to 300 residents of socio-economically contrasting neighborhood areas. Social class was operationalized by Erik Olin Wright’s social class position typology, based on ownership and control over productive assets. The method of multiple correspondence analysis (MCA) was also applied to analyze the collected data. Results: The results indicated that mental distress was significantly differentiated across social classes and in each residential area. Unemployed and unskilled workers were the most vulnerable groups in terms of psychological health. Chronic stress arose in this study as a risk factor for poor mental health outcomes and it was associated to low marital quality, intense economic burden and impoverished housing conditions. Conclusion: Those who face income loss, job loss and disability are at high risk for poverty and marginalization, suffering from greater psychological distress.

Studies of xenophobia have focused either on socio-economic context that accentuates xenophobic attitudes or on perceptions of immigrants, namely symbolic and realistic threats as well as on social distance from immigrants. This study examines closely the relationship among various components of xenophobia and their contribution in the formation of particular xenophobic groups. The analysis identified four different xenophobic groups, i.e. a) The distant xenophobic group, b) The core xenophobic group, c) The subtle xenophobic group and d) The ambivalent xenophobic group. The groups’ profiles are synthesized through negative, neutral and positive properties of overall attitudes towards immigrants, perceived threats, political xenophobia, social distance, authoritarian attitudes and individual social characteristics. The survey results demonstrate that a multidimensional conceptualization of xenophobia is needed both at the level of objective social condition and of individual and collective perceptions.

Socioeconomic health inequalities in adolescence are not consistently reported. This may be due to the measurement of self-reported general health, which probably fails to fully capture the psychological dimension of health, and the reliance on traditional socio-economic indicators, such as parental education or occupational status. The present study aimed at investigating this issue using simple questions to assess both the physical and psychological dimension of health and a broader set of socioeconomic indicators than previously used.

This paper reports on a large scale cross‐sectional study examining subjective perceptions of community social life held by a randomly selected sample of residents (n = 428) in all small rural settings (n = 89) of the region of North Aegean Sea. The notion of social capital was used as a conceptual tool in order to explore different aspects of the relational life of contemporary rural communities. This study has two aims: First to provide an account of rural residents' perceptions of village life in terms of interpersonal support, mutual aid, trust, social cohesion and community competence, and second to examine the suitability of the social capital notion within the specific cultural context. A combination of data collection procedures and a range of sources were employed, such as key informants, rural residents and researchers' field observations. The findings indicate that small farming communities of high devotion with deep roots and strong sense of belonging face severe demographic imbalance and experience low civic power given the limited links with external agents. The mainstream notion of social capital as an unconditionally beneficial factor is thus questioned. The findings call for revisiting its relevance across communities with varying capacities and needs. Copyright © 2009 John Wiley & Sons, Ltd.