Health perception of a population-based study from 2006 to 2023 using multilevel modelling

We aimed to analyze the variations in health perception among the Brazilian population, aggregated over 17 years of observation (2006-2023), considering individual and contextual characteristics. A total of 799,695 participants were included in the study, which had their data collected from the website of the Health Surveillance Secretariat, where the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel) is publicly available. Multilevel regression analysis was used to estimate the values of health perception among the Brazilian population, aggregated by year, region, BMI, education, sex, and exercise time. Based on the results, it was verified that over the years, health perception values decreased and there is a substantial disparity between Brazilian regions. Additionally, individuals with a healthy weight presented higher health perception values, individuals with more years of education had substantially higher health perception values and individuals who reported engaging in more than 30 min of exercise, when they exercised, had substantially higher health perception values. No differences in health perception were found between females and males. These findings highlight the need to prioritize actions to promote physical activity, increasing the availability, access and quality of public places, preferably with assistance/exercise prescription in these places and free of charge. It is essential to assess past initiatives and integrate efforts to optimize future strategies and to identify strategies that reduce inequities in access to health-promoting environment.