The research protocol was designed to guide collaborating groups in cities in developing and developed countries to use a standardized method to assess their community’s age-friendliness and identify areas for remedial action at the same time as they contributed to WHO’s objective of identifying the essential features that constitute an age-friendly city. The protocol had to be straightforward, require a minimum of material and technical resources, and be adaptable to varying cultural and economic contexts. The broad lines of the methodology were defined in consultation with a group of advisers who had expertise in policy, community action, or qualitative research, and who were familiar with the social context of developing as well as developed countries. The draft protocol was then reviewed and finalized at a workshop in Vancouver, Canada, in March 2006, attended by project leaders from most of the participating cities then enlisted. The “Vancouver protocol,”17 as it became known, was adopted in all cities that participated in the research.
With adaptations to accommodate communities in widely varying countries, a set of eight features of urban life was identified for examination in the Vancouver protocol based on the WHO concept of active aging as well as on the key features identified by existing elder-friendly community models. The topic areas explored in the focus groups were: outdoor spaces and public buildings, transportation, housing, social participation, respect and social inclusion, civic participation and employment, communication and information, community support, and health services. In semi-structured focus groups, participants were asked to identify the positive and negative features of the city in each of these eight major areas and to offer suggestions for improvement. To prepare participants for the discussions, local project leaders were encouraged to distribute the list of topic areas when participants were recruited.
In all, the focus group research was conducted in 33 cities1 situated in 22 countries of North and South America, Western Europe, Russia, the Eastern Mediterranean, Africa, the Indian sub-continent, Oceania, and the Pacific Rim. Of the 33 participating sites, 19 were in developing countries, and 14 were in industrialized countries. The cities represent the diversity of contemporary urban settings. There were seven mega-cities with over 10 million inhabitants (Mexico City, Moscow, New Delhi, Rio de Janeiro, Istanbul, Shanghai, and Tokyo) and large metropolises, such as Nairobi and London. Also included were smaller but regionally significant urban centers such as Geneva, Amman, Melbourne, Islamabad, Kingston, and Halifax, as well as towns located near metropolitan areas [e.g., Melville, adjacent to Perth, Australia; Saanich, near Buenos Aires, Argentina; and La Plata, close to Buenos Aires (Argentina)]. Project sites and leaders were recruited through informal networks of the WHO project leaders, formal representation to municipal or state governments, and promotion of the project at professional conferences. A grant from the Public Health Agency of Canada allowed WHO to award small research contracts to non-government organizations and research centers to enable the inclusion of several project sites in the developing world: Kingston, Montego Bay, Mexico City, San Jose, Rio de Janeiro, La Plata, Tripoli, and Nairobi. Also, Help the Aged UK contracted with HelpAge India to conduct the research in two sites in India: New Delhi and Udaipur.
Informed consent and local ethics review was mandatory, recognizing variations in local practices and legal requirements. A procedure for obtaining informed consent adapted from the Pan-American Health Organization SABE Survey (Survey on Health, Wellbeing and Aging in Latin America and the Caribbean)18 was proposed for study sites which had no accepted practices in place.