A Two-stage Concept Mapping for Emerging Concepts: An Analysis of the Smart Healthy City

A Two-stage Concept Mapping for Emerging Concepts: An Analysis of the Smart Healthy City | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article A Two-stage Concept Mapping for Emerging Concepts: An Analysis of the Smart Healthy City Jieun Kim, Sungmin Son, Haejoo Chung, Kyungsuk Ryu, Dasom Lee, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5326308/v2 This work is licensed under a CC BY 4.0 License Archived Versions: Posted Version 2 posted You are reading this latest preprint version Version 1 posted Abstract Rapid urbanization and technological advancement pose complex challenges to urban health governance, particularly amid demographic aging, environmental pressures, and widening health inequalities. While Smart Healthy Cities (SHCs) offer a promising paradigm to address these issues, current models lack a comprehensive, theoretically grounded framework for implementation. This study defines the SHC concept and examines its relevance for building inclusive, age-friendly urban environments. An innovative two-stage concept mapping methodology was employed, integrating qualitative insights from expert-focused group interviews with quantitative analysis using multidimensional scaling and hierarchical cluster analysis. A diverse panel of experts from public health, urban planning, digital innovation, and governance participated in the process. Four key dimensions of SHCs were identified: Healthy Environment Cities (emphasizing physical infrastructure), Smart Networking Cities (focusing on digital connectivity), Socially Sustainable Cities (advancing inclusive policies), and Health Empowering Cities (supporting individual capabilities and preventive health). These dimensions were found to contribute differentially to three core SHC objectives: health equity, smart connectivity, and system-level resilience. Priority concepts included improved healthcare access, intergenerational technology integration, and lifespan-oriented disease prevention. Pattern matching and go-zone analyses revealed a notable discrepancy: social sustainability, while conceptually important, was under-prioritized in implementation. The framework incorporates six theoretical perspectives—socio-ecological theory, smart city theory, health equity, systems thinking, the capabilities approach, and participatory urban planning—offering a multidimensional and systems-informed model. By conceptualizing cities as complex adaptive systems, this framework aligns digital innovation with equity and resilience goals. It provides urban planners and policymakers with a roadmap to develop inclusive, sustainable, and health-promoting cities. The study also contributes to Smart Healthy Age-Friendly Environment (SHAFE) discourse by expanding its application beyond aging populations to all urban residents. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Full Text Additional Declarations No competing interests reported. Supplementary Files 25041804HSSCSupplement.docx Cite Share Download PDF Archived Versions: Posted Version 2 posted You are reading this latest preprint version Version 1 posted Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5326308","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[{"code":2,"date":"2025-10-01 12:43:55","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"humanities-and-social-sciences-communications","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"palcomms","sideBox":"Learn more about [Humanities \u0026 Social Sciences 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1","display":"","copyAsset":false,"role":"figure","size":1276837,"visible":true,"origin":"","legend":"\u003cp\u003eThe Two-Stage Concept Mapping Procedure\u003c/p\u003e","description":"","filename":"Figure1TheTwoStageConceptMappingProcedure.png","url":"https://assets-eu.researchsquare.com/files/rs-5326308/v2/562311b8e44f240b26d6478a.png"},{"id":92594431,"identity":"e2e19266-224f-4793-80ad-2d87ae194c5b","added_by":"auto","created_at":"2025-10-01 12:52:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1028813,"visible":true,"origin":"","legend":"\u003cp\u003eFour-cluster Concept Map of a Smart Healthy City\u003c/p\u003e","description":"","filename":"Figure2FourclusterConceptMapofaSmartHealthyCity.png","url":"https://assets-eu.researchsquare.com/files/rs-5326308/v2/b4868ec322e81d4b3b97c0ac.png"},{"id":92595294,"identity":"e826494a-9307-44e6-9f16-ff0b55aeb857","added_by":"auto","created_at":"2025-10-01 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13:00:00","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":1224058,"visible":true,"origin":"","legend":"\u003cp\u003eA Conceptual Framework for SHCs\u003c/p\u003e","description":"","filename":"Figure5AConceptualFrameworkforSHCs.png","url":"https://assets-eu.researchsquare.com/files/rs-5326308/v2/b7327c02383f4bce63b9e7df.png"},{"id":98815481,"identity":"cca4f86f-423a-4c8e-be81-acf1b1568b6c","added_by":"auto","created_at":"2025-12-22 16:14:38","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5964905,"visible":true,"origin":"","legend":"","description":"","filename":"250929Cleanwtables.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5326308/v2_covered_f0238ec7-b0b5-4035-bdb2-3b1755bfcc53.pdf"},{"id":92594204,"identity":"b9b38236-f9cc-4b57-a48a-93eaba3b4406","added_by":"auto","created_at":"2025-10-01 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City","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"humanities-and-social-sciences-communications","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"palcomms","sideBox":"Learn more about [Humanities \u0026 Social Sciences Communications](http://www.nature.com/palcomms/)","snPcode":"41599","submissionUrl":"https://submission.springernature.com/new-submission/41599/3","title":"Humanities and Social Sciences Communications","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5326308/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5326308/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eRapid urbanization and technological advancement pose complex challenges to urban health governance, particularly amid demographic aging, environmental pressures, and widening health inequalities. While Smart Healthy Cities (SHCs) offer a promising paradigm to address these issues, current models lack a comprehensive, theoretically grounded framework for implementation. This study defines the SHC concept and examines its relevance for building inclusive, age-friendly urban environments.\u003c/p\u003e\u003cp\u003eAn innovative two-stage concept mapping methodology was employed, integrating qualitative insights from expert-focused group interviews with quantitative analysis using multidimensional scaling and hierarchical cluster analysis. A diverse panel of experts from public health, urban planning, digital innovation, and governance participated in the process.\u003c/p\u003e\u003cp\u003eFour key dimensions of SHCs were identified: Healthy Environment Cities (emphasizing physical infrastructure), Smart Networking Cities (focusing on digital connectivity), Socially Sustainable Cities (advancing inclusive policies), and Health Empowering Cities (supporting individual capabilities and preventive health). These dimensions were found to contribute differentially to three core SHC objectives: health equity, smart connectivity, and system-level resilience. Priority concepts included improved healthcare access, intergenerational technology integration, and lifespan-oriented disease prevention.\u003c/p\u003e\u003cp\u003ePattern matching and go-zone analyses revealed a notable discrepancy: social sustainability, while conceptually important, was under-prioritized in implementation. The framework incorporates six theoretical perspectives\u0026mdash;socio-ecological theory, smart city theory, health equity, systems thinking, the capabilities approach, and participatory urban planning\u0026mdash;offering a multidimensional and systems-informed model.\u003c/p\u003e\u003cp\u003eBy conceptualizing cities as complex adaptive systems, this framework aligns digital innovation with equity and resilience goals. It provides urban planners and policymakers with a roadmap to develop inclusive, sustainable, and health-promoting cities. 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