An evidence-informed participatory model using the Nominal Group Technique to prioritise active and healthy ageing interventions

Abstract

Objective: To identify and prioritise interventions to promote Active and Healthy Ageing (AHA) among middle-aged adults (55-64 years) living in a rural context. Methods: A participatory qualitative study was conducted in two complementary phases. Phase 1 integrated quantitative and qualitative evidence generated by two previous studies in the Baixo Alentejo, Southern Portugal. The quantitative study showed that sex, employment status and self-perceived income were significantly associated with physical, mental and social well-being. The qualitative study identified key ageing-related expectations, including autonomy, preservation of family and community ties, the use of digital technologies to support independence and social interaction, and the central role of nurses in health education, follow-up and the promotion of healthy lifestyles. In Phase 2, a face-to-face Nominal Group Technique (NGT) session was conducted with 20 intersectoral stakeholders, including institutional representatives, health and social care professionals, and community members, followed by a feasibility appraisal of the proposed interventions using the APEASE framework. Results: A total of 40 intervention proposals were generated and consolidated into 31 unique interventions after clarification and removal of duplicates. Anonymous voting identified five priority interventions: (1) periodic nursing consultations with multidimensional assessment and referral; (2) multidisciplinary consultations in primary care; (3) labour time-flexibility measures to facilitate the adoption of health-promoting behaviours; (4) use of communication technologies to improve access to health and safety services; and (5) professionally mediated peer-support groups. Overall, the highest-ranked interventions clustered within the health pillar and achieved the highest APEASE scores, indicating greater acceptability and feasibility for real-world implementation. Conclusion: In rural settings, primary care services provide a key operational arena for translating Active and Healthy Ageing priorities into practice. Nurse-led care, multidisciplinary follow-up, labour flexibility, digital connectivity and peer support constitute a coherent set of context-sensitive strategies with strong potential to enhance functional capacity, social participation and the sustainability of ageing policies in low-density territories.