Occupational health risks and provision gaps among live-in caregivers: findings from a qualitative interview study of Polish live-ins in Germany.

Noncommunicable diseases (NCDs) remain a dominant global health burden, with the World Health Organization (WHO) reporting at least 43 million deaths from NCDs in 2021, representing a large majority of non-pandemic-related deaths worldwide . In the Philippines, the pattern is similarly pressing: WHO's country profile indicates that in 2021, NCDs accounted for about 68% of all deaths, highlighting the continuing need for prevention, health promotion, and sustained community-level action . Alongside NCD risks, preventable conditions shaped by social determinants persist. National nutrition surveillance reports, for instance, show that 23.6% of Filipino children under five were stunted in 2023, signaling chronic constraints on growth and well-being that require locally responsive, equity-oriented solutions . Addressing these challenges requires clarity about the core constructs being promoted and evaluated. Health is commonly anchored in WHO's constitutional definition as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” . Wellness, by contrast, is often framed as an active, holistic, and developmental process that integrates multiple dimensions of functioning and everyday practice, extending beyond clinical status to how people live, cope, and thrive , . In community settings, these distinctions matter because programs may succeed in delivering activities yet still fall short if community members do not experience changes as meaningful, feasible, or culturally fitting. A third construct, community engagement, is central to how public health and wellness initiatives become sustainable. defines it as “…the process of working collaboratively with groups of people who are affiliated by geographic proximity, special interests, or similar situations with respect to issues affecting their well-being…” (, p. 7). Engagement is more than a participation count; it reflects relationship-building, trust, shared decision-making, and local ownership, which shape adoption and continuation of health-promoting behaviors. These ideas align with socioecological and empowerment-oriented perspectives that locate health behavior within interacting levels of influence (intrapersonal to policy) and emphasize community capacity and control as part of health promotion practice , . In this study, the socioecological lens guides how barriers and enabling conditions are organized across levels (individual, interpersonal, community, and policy), while the empowerment lens guides interpretation of narratives related to voice, shared decision-making, and perceived control that support sustained engagement.