The World Health Organization engages cities and communities all over the world in becoming age-friendly. There is a need for assessing the age-friendliness of cities and communities by means of a transparently constructed and validated tool which measures the construct as a whole. The aim of this study was to develop a questionnaire measuring age-friendliness, providing full transparency and reproducibility. The development and validation of the Age Friendly Cities and Communities Questionnaire (AFCCQ) followed the criteria of the COnsensus-based Standards for selection of health Measurement INstruments (COSMIN). Four phases were followed: (1) development of the conceptual model, themes and items; (2) initial (qualitative) validation; (3) psychometric validation, and (4) translating the instrument using the forward-backward translation method. This rigorous process of development and validation resulted in a valid, psychometrically sound, comprehensive 23-item questionnaire. This questionnaire can be used to measure older people’s experiences regarding the eight domains of the WHO Age-Friendly Cities model, and an additional financial domain. The AFCCQ allows practitioners and researchers to capture the age-friendliness of a city or community in a numerical fashion, which helps monitor the age-friendliness and the potential impact of policies or social programmes. The AFCCQ was created in Dutch and translated into British-English.

The World Health Organization (WHO) strives to assist and inspire cities to become more ‘age-friendly’ through the Global Age-Friendly Cities Guide. An age-friendly city offers a supportive environment that enables residents to grow older actively within their families, neighbourhoods and civil society, and offers extensive opportunities for their participation in the community. In the attempts to make cities age-friendly, ageism may interact with these developments. The goal of this study was to investigate the extent to which features of age-friendly cities, both facilitators and hindrances, are visible in the city scape of the Dutch municipalities of The Hague and Zoetermeer and whether or not ageism is manifested explicitly or implicitly. A qualitative photoproduction study based on the Checklist of Essential Features of Age-Friendly Cities was conducted in five neighbourhoods. Both municipalities have a large number of visual age-friendly features, which are manifested in five domains of the WHO model, namely Communication and information; Housing; Transportation; Community support and health services; and Outdoor spaces and buildings. Age-stereotypes, both positive and negative, can be observed in the domain of Communication and information, especially in the depiction of third agers as winners. At the same time, older people and age-friendly features are very visible in the cityscapes of both municipalities, and this is a positive expression of the changing demographics.

ObjectivesMost complex healthcare interventions target a network of healthcare professionals. Social network analysis (SNA) is a powerful technique to study how social relationships within a network are established and evolve. We identified in which phases of complex healthcare intervention research SNA is used and the value of SNA for developing and evaluating complex healthcare interventions.MethodsA scoping review was conducted using the Arksey and O’Malley methodological framework. We included complex healthcare intervention studies using SNA to identify the study characteristics, level of complexity of the healthcare interventions, reported strengths and limitations, and reported implications of SNA. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews 2018 was used to guide the reporting.ResultsAmong 2466 identified studies, 40 studies were selected for analysis. At first, the results showed that SNA seems underused in evaluating complex intervention research. Second, SNA was not used in the development phase of the included studies. Third, the reported implications in the evaluation and implementation phase reflect the value of SNA in addressing the implementation and population complexity. Fourth, pathway complexity and contextual complexity of the included interventions were unclear or unable to access. Fifth, the use of a mixed methods approach was reported as a strength, as the combination and integration of a quantitative and qualitative method clearly establishes the results.ConclusionSNA is a widely applicable method that can be used in different phases of complex intervention research. SNA can be of value to disentangle and address the level of complexity of complex healthcare interventions. Furthermore, the routine use of SNA within a mixed method approach could yield actionable insights that would be useful in the transactional context of complex interventions.

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