Community residents who were older than 19 years, living in a metropolitan city in Korea, and able to read and write were invited to use the platform. Adverts about the platform and information about the study were shared via the network of the City Social Welfare Center. People interested in the new community care platform were invited to use it. Data from individuals who completed the comprehensive health- and social-care assessment process (Figure 1) were exported from the platform and analyzed in the study.

The CHSNA system, which was based on the ICF framework, was integrated into the online community care platform [20]. A description of the development and content of CHSNA system has been published previously [21]. This system provided comprehensive information regarding the health and social needs of the participants, corresponding to the ICF’s components through three assessment steps (Figure 1), including a basic health assessment, a life and activity assessment, and an in-depth health assessment. Firstly, the participant created an account with a username and contact information (phone number or email address). They could access the platform with a hyperlink via a web browser on any device with an internet connection, such as a smartphone, tablet, or computer. They were encouraged to use the platform as needed for 2 months. People who were not able to use the platform by themselves could receive assistance from caregivers and social workers.

After activating an account in the community care platform, the user continued to the first assessment step to provide general information (e.g., demographic, household, and health behaviors) by filling in blank items. The system automatically moved to the next step after the user completed the items in each step.

Next, their needs for performing daily activities, including activities of daily living (ADL), instrumental activities of daily living (IADL), and recreational and social participation activities, were assessed by short questions for which there were four possible responses: “not applicable,” “doing this activity well,” “want to do this activity better,” and “want to try to do this activity.” Participants who chose “want to do this activity better” or “want to try to do this activity” were grouped as having needs for that particular activity. The questions were based on a survey from the National Leisure Activity Survey of Ministry of Culture, Sports, and Tourism [22].

The in-depth assessment step evaluated physical impairment, activities and participation, and environmental status. The WHO Multi-Country Survey Study on Health and Responsiveness [23] was adopted to assess impairment related to participants’ physical health. Items were evaluated using a 5-point Likert scale ranging from 0 (no difficulty) to 4 (extreme difficulty). The WHODAS 2.0 was used to evaluate the difficulty level of functional status with regard to activity and participation [10]. This instrument included six domains covering 36 items measured on the following 5-point scale: 1, no difficulty; 2, mild difficulty; 3, moderate difficulty; 4, severe difficulty; and 5, extreme difficulty. The overall score was transformed into a metric ranging from 0 (no disability) to 100 (full disability); higher scores indicate greater disability in terms of performing the tasks in activity and participation. We considered a disability score equal to or greater than 25 to indicate disability [10]. Environmental problems were assessed by binary yes-or-no questions about their housing and living environmental problems, where “yes” meant that participants had difficulties related to housing and their living environment, and “no” meant they had no such difficulties. The items included in the environmental problems component were adopted from the final report of a community health survey conducted by the Korea Disease Control and Prevention Agency [24].

All items of the assessment steps were mapped to the ICF framework during the CHSNA system development; therefore, the profile indicating community residents’ functional status and health and social needs were illustrated using the corresponding ICF categories (Figure 2).

SPSS version 26 (IBM Corp., Armonk, NY, USA) was used to perform analyses. The variables are described using mean ± standard deviation or frequency and percentage values. In this study, we linked and presented the health and social needs of participants to the ICF second-level domain; this linking rule was applied in a previous study to link health needs according to disability type using the ICF [25]. ICF categories that were reported by ≥5% of the participants were considered to be frequent health and social needs. There was no specific reference for the percentage threshold used to define frequent needs; however, we referred to a study reporting that the frequent ICF categories related to rehabilitation goals fluctuated from 5%–9% [26]. Therefore, we chose 5% as the cut-point for frequent needs in this study.

The study procedures were reviewed by the Chungnam National University Institutional Review Board (IRB), and the study was exempted from ethical approval by the IRB of the authors’ affiliated university (No. 201904-SB-037-01). Regarding informed consent, the participants were asked whether they agreed with the use of their data for research purposes when they logged onto the platform for the first time. No identified personal information of the users was included in this study.

Over the 2-month study period, 398 people created an account on the platform, of whom 283 filled in their basic information (step 1), 269 assessed their needs for activities of daily living (step 2), and 190 completed the three assessment steps of the CHSNA system. Data from those 190 users were analyzed. The number of users who completed each assessment step is shown in Figure 3, and the characteristics of the participants are summarized in Table 1. Data were collected from 190 community residents who were predominantly female (n = 159; 83.7%) and were aged 42.7 ± 17.8 years (range, 20–90 years). More than half of the participants were young adults aged between 19 and 44 years, while elderly participants accounted for 15.3%. Sixty-four (33.7%) participants reported that they had at least one chronic condition. The four most commonly self-reported chronic conditions were hypertension (17.4%), hyperlipidemia (9.5%), diabetes (5.8%), and arthritis (5.8%).

The number of people with needs in performing daily living activities was displayed as percentages. Infographics were created to represent 62 assessment items regarding needs for participating in daily living activities, which included five domains: ADL, IADL, indoor and outdoor recreational activities, and social participation activities (Figure 4). The most common need related to ADL was for self-care activities such as cooking to maintain independent care of oneself, which was reported by more than 20% of the participants. Among the IADL allowing an individual to live independently in the community, the most frequent needs were found for driving and managing money, which were reported by more than 15% of participants. The prevalence of the need to participate in social activities fluctuated between 5% and >25% of participants. Community residents had a greater desire to participate in outdoor recreational and social activities, with a prevalence of >35%.

Regarding physical health assessment, participants’ impairment levels ranged from 10% to 80% (Figure 5). The highest levels of impairment were reported for pain and discomfort, accounting for 79.4% and 73.5% of participants, respectively. Difficulties in activities and in participation were reported by 10%–45% of participants (Figure 6). The total WHODAS 2.0 score for the 36 items of activity and participation was 12.16 (standard deviation 15.09), which means the participants experienced difficulties performing activities and participating in their daily life, but they did not yet have disabilities in performing these tasks. In the assessment of environmental problems (Figure 7), the most common problem that participants experienced in their homes was noise (17%), followed by a lack of safety due to crime and an insufficient hot water supply, which were reported by 14% and 12% of participants, respectively.

The health and social needs among community residents were matched to 117 ICF categories, which covered all ICF components, with the most common being activities and participation (47%), followed by body functions (28.2%) (Figure 8). Figure 9 presents the most frequently reported needs, which related to body functions and activities/participation. Within the “body functions” ICF component, the most frequently reported issues were with sleep functions (20.1%), muscle power functions (17.4%), and mobility of joint functions (16.8%). Within the activities and participation component, the most common need among participants (12.6%) was handling stress and other psychological demands (12.6%).