The Population Experience Observatory: A Community-Based Approach to Health in Rural Tuscany, Italy

Abstract Background Rural areas face overlapping challenges-aging populations, depopulation, and limited services-that weaken access to quality healthcare. Traditional top-down approaches often miss local assets. The Proximity Care and Tuscany Health Ecosystem projects adopt a bottom-up model, co-developing innovations with three rural communities (Serchio Valley, Casentino, Elba Island), reversing the usual urban-to-rural flow of innovation. The Population Experience Observatory (PEO) supports this by gathering residents’ lived experiences and involving them as active agents of change. Methods The PEO is an open online survey for adult residents in the target areas. Participation is voluntary, with an option to join a local panel for follow-up and research activities. The survey covers satisfaction with public and healthcare services, life satisfaction, sense of community, and individual factors such as demographics, health, caregiving roles, social support, and third-sector involvement. Data collection began in April 2023 (Serchio Valley), May 2024 (Casentino), and October 2024 (Elba Island), and is ongoing. Results By April 2025, 4,487 residents accessed the survey; 1,923 completed it, and 651 joined the panel. Satisfaction with services was low (means out of 10: 5.4 healthcare, 5.2 social services, 4.3 transport), while life satisfaction (6.9) and sense of community (7.0) were higher. Residents expressed strong attachment (8.0), satisfaction with living locally (7.2), and willingness to contribute (7.1). About 27% were actively involved in volunteering. Results are regularly shared with local institutions. In January 2025, panelists joined the first focus groups on quality of life and health promotion. Conclusions Community-generated data can inform targeted action and highlight local resources. Rural Tuscany shows strong community capacity, but achieving community empowerment requires moving from consultation to engagement. Key messages • PEO represents an innovative bottom-up approach valuing community resources, challenging traditional healthcare models and promoting co-development solutions with citizens. • Rural areas in Tuscany show strong sense of community, which can support the shift toward communities as key actors in health innovation - but lasting impact depends on sustained resident engagement.