This study was conducted in Bogotá, Colombia’s capital, which has 7.9 million inhabitants, 52.1% are women [13]. In 2021, 35.4% of women in Bogotá spent over 5 h a day on unpaid care work compared to 8.6% of men [14]. The Care Blocks are located in neighborhoods with the highest concentration of unpaid caregivers, care recipients, and poverty rates (Fig. 1) [7]. In October 2020, the first Care Block was opened in Ciudad Bolívar, an administrative area with 656,015 inhabitants, of whom 10.9% live in multidimensional poverty, and 8.03% are victims of the Colombian armed conflict [15]. Women living in this area face the feminization of poverty and high rates of gender-based violence [16].

Map of Care Blocks in Bogotá, Colombia, and offered infrastructure in Ciudad Bolivar – Manitas’ Care Block. a depicts the geographic distribution of Care Blocks in Bogotá, Colombia, based on neighborhood income. Note that all Care Blocks are located in low-income neighborhoods. b depicts a picture of Ciudad Bolivar – Manitas Care Block with the offered services or infrastructure

Ciudad Bolivar’s Care Block provides the following services: (i) high school curricula, tertiary education, entrepreneurship classes, and career counseling; (ii) psychosocial and self-care programs; (iii) health promotion services including therapy, family medicine appointments, and physical activity classes; (iv) a laundromat; and (v) care training for the broader community (Fig. 1) [6].

This mixed methods study used a simultaneous integration approach [17], within a socio-ecological framework [18], to document the multi-level perceptions of caregivers and stakeholders (e.g., policymakers, implementers, and researchers). The quantitative component included a survey and contextually based systematic observational measurements in the Care Block facility terrace. The qualitative component included the Our Voice community-based citizen science method [9], in which we incorporated a virtual reality visualization tool to facilitate discussions regarding recommendations for change. The methods and data harmonization are illustrated in Fig. 2.

Methodological approach to characterize caregivers’ access to and use of the Care Block program in Bogota, Colombia. This figure depicts the relationship between the multiple methods, altogether aimed at facilitating the understanding of caregivers’ access and use to the Care Block program

A convenience sample of participants completed two surveys; the first, implemented between June 24 and July 11, 2022, included sociodemographic characteristics (participants’ age, sex, education, and household socioeconomic status) and care-related information (caregiving time, demographics of dependents, and Care Block use). The second survey was conducted from November 18th to November 22nd, 2022. In this survey, we measured participants’ subjective well-being and mental health symptoms.

Subjective well-being was evaluated using a core question on life satisfaction from the Organization for Economic Co-operation and Development’s (OECD) subjective well-being questionnaire [19]. OECD defines subjective well-being as a personal perception that involves a reflective evaluation of a person’s life or specific circumstances, pleasant or unpleasant emotional experiences, and personal development [19]. Responses to this question are rated on a scale of 1–10 where higher scores indicate higher life satisfaction.

Mental health symptoms (depression and generalized anxiety) were measured using the PHQ-4 questionnaire [20]. Depression symptoms included anhedonia and hopelessness [20]. Generalized anxiety symptoms included emotional and cognitive experiences of generalized anxiety in the last 2 weeks [20]. The questionnaire generates two domain scores (depression [PHQ-2] and generalized anxiety [GAD-2]), each rated on a scale of 0–6 where scores equal to or higher than 3 indicate symptoms of depression or generalized anxiety. For the statistical analysis, we included descriptive statistics (mean, standard deviation, and percentages).

From December 13 to December 18, 2021, we used SOPARC [21] to assess physical activity levels on a terrace of the Care Block facility where physical activity classes were offered. The terrace was divided into 8 target areas. Two 20-min observations were made on a non-PA class day, and during physical activity classes, four 15-min observation periods were conducted. These observation periods took place 10-min before the class, 10-min and 40-min following the beginning of the class, and 10-min after the class finished. The data collected included the number of users according to sex (man, woman), age group (children, adolescents, adults, or older adults), physical activity levels (sedentary, moderate, or vigorous), and area conditions (accessible, usable, equipped, supervised, organized, or empty). The quality of the Care Block facility was assessed with the Physical Activity Resource Assessment [22]. Comparisons between categorical variables in the user characteristics were tested with a chi-squared test.

Our Voice engages community residents as citizen scientists in identifying and changing features of their local environments [10]. From September 2021 to May 2023, we expanded on the standard 4-step Our Voice method (discover, discuss, activate, and change) by adding two steps: “engage” and “visualize.” Using the six-step approach, caregivers identified the built and social environmental facilitators and barriers to accessing the Care Block facility, along with activating feasible steps to foster positive change.

On September 18, 2021, we conducted a focus group with caregivers to discuss their perceptions and experiences regarding the Care Block program. The focus group was co-created with Bogotá’s District Secretariat for Women. The session consisted of three steps: (i) the attendees rotated through 5 thematic tables facilitated by project members to identify their perceptions and experiences about Ciudad Bolívar’s Care Block; (ii) the group reconvened, and each project member reported the insights discussed at their table while the others simultaneously mapped the insights using the XMind program [23]; and (iii) the group discussed and adjusted the diagrams.

In June 2022, caregivers performed community walks to identify local facilitators and barriers to access the Care Block. Community walks were implemented using the Discovery Tool mobile application, which allows participants to capture geocoded photographs and audio/text narratives of features during their journey from their homes to the Care Block facility and vice-versa.

We facilitated two community meetings. In the first one, conducted on July 16th, 2022, citizen scientists reviewed and organized their Discovery Tool data on a whiteboard, identified common themes, collectively prioritized issues, and suggested potential solutions. In the second one, conducted on October 3th, 2022, participants engaged in role-play activities to simulate an experience with stakeholders and then chose five representatives to participate in the subsequent Visualize step.

We developed a Virtual Reality Experience (VRE) to share the results and leverage community advocacy with stakeholders by immersing them in a simulation of visual and auditory caregiver walking experiences. The VRE captured five travel experiences to the Care Block that reflected the most mentioned themes. Research staff then returned to these hotspot areas to gather GoPro Max™ 360-degree footage and ambient sound recordings. The Our Voice audio recordings were then overlaid onto the GoPro footage with an accompanying voice-over that introduced each participant. The experience was designed using the Unity™ game engine [24]. On February 9, 2023, five citizen scientists tested the VRE using the Oculus Quest 2™ virtual reality headset and were trained to guide the stakeholders on using the immersive headset.

On March 9, 2023, citizen scientists and stakeholders participated in a 2.5-h community meeting designed to identify feasible actions to improve access to Ciudad Bolivar’s Care Block. During the session, participants guided stakeholders through the VRE. Simultaneously, all meeting attendees viewed the projections of the immersive headset on a large screen. Then, the group shared their most relevant concerns with the policymakers and proposed solutions to those issues. At the end of the meeting, attendees responded to a virtual reality perception survey.

Between May 16 and June 5, 2023, we handed citizen scientists an informational guide detailing web page services and trained one caregiver to navigate the informational resource, enabling her to explain it to the rest of the group. Moreover, we held in-person and virtual meetings to disseminate our results with different stakeholders: on May 4, 2023, independently with policymakers from the District Secretariat of Planning, Women, and Habitat; on May 16, 2023, with one citizen scientist; and on May 30, 2023, with a policymaker from Bogota’s Ciudad Bolivar Local Mayors’ Office. Additionally, between May 31 and June 2, 2023, we attended the Smart Cities Expo Bogotá 2023 to disseminate results.

Applying the multi-level socio-ecological framework [18], the Discovery Tool data were analyzed using a content analysis approach and intercoder reliability to characterize themes at the individual, interpersonal, community, policy, and environment levels.