A methodological comparison exploring urban environment and physical activity in Bilbao, Spain

Abstract Urban design influences residents’ physical activity, so exploring experiences via qualitative methods is vital for public health. Citizen science approaches like Photovoice empower communities to identify facilitators and barriers, but these methods have yet to be combined. This study compares a participatory “lived experience” lens with structured content analysis to guide urban planning and health policy in Bilbao, Spain. A qualitative study was conducted in Bilbao using CBPR and PAR. In 2021, five men participated in five Photovoice sessions to document urban factors affecting physical activity. In 2024, two researchers applied content analysis to session transcripts, with iterative coding and team validation. The analysis explored insights emerging from each analytical lens to understand their complementarity. Photovoice analysis revealed five categories and 13 subcategories: exercise (walking, river use, sports, elderly), mobility choices (transport, free sidewalks), pedestrian-vehicle conflicts (poor signage, congestion, safety), obstacles (construction works, leisure-related barriers), deterioration (neglected spaces, lack of civility). Content analysis revealed broader themes: urban spaces (physical features, transformations, social impact), public resources (community initiatives, bike-sharing), walkability and mobility (sidewalk and streets conditions, traffic, distinct roles), urban policy (planning, regulatory needs, citizen involvement). While the participatory approach boosted agency and local reflection, content analysis addressed structural and policy issues not always visible to residents. Integrating participatory and analytical discourse techniques offers complementary insights into how urban environments influence physical activity. While Photovoice revealed concrete, visible elements, content analysis uncovered structural dimensions of urban health. This dual approach empowers communities while strengthening evidence-based urban health strategies. Key messages • Blending participatory analysis and traditional qualitative techniques offers complementary insights into urban health research. • This dual approach enriches the perception of participants in the photovoice and informs inclusive urban planning for health promotion.