RESUMO
Previous research has shown that environments with features that encourage walking are associated withincreased physical activity. Existing methods to assess the built environment using geographical information systems (GIS)data, direct audit or large surveys of the residents face constraints, such as data availability and comparability, when used tostudy communities in countries in diverse parts of the world. The aim of this study was to develop a method to evaluatefeatures of the built environment of communities using a standard set of photos. In this report we describe the method ofphoto collection, photo analysis instrument development and inter-rater reliability of the instrument.Methods/Principal Findings: A minimum of 5 photos were taken per community in 86 communities in 5 countriesaccording to a standard set of instructions from a designated central point of each community by researchers at each site. Astandard pro forma derived from reviewing existing instruments to assess the built environment was developed and used toscore the characteristics of each community. Photo sets from each community were assessed independently by threeobservers in the central research office according to the pro forma and the inter-rater reliability was compared by intra-classcorrelation (ICC). Overall 87% (53 of 60) items had an ICC of $0.70, 7% (4 of 60) had an ICC between 0.60 and 0.70 and 5% (3of 60) items had an ICC #0.50.Conclusions/Significance: Analysis of photos using a standardized protocol as described in this study offers a means toobtain reliable and reproducible information on the built environment in communities in very diverse locations around theworld. The collection of the photographic data required minimal training and the analysis demonstrated high reliability forthe majority of items of interest.
Assuntos
Atividade Motora , Exercício Físico , MétodosRESUMO
BACKGROUND: The environment in which people live is known to be important in influencing diet, physical activity, smoking, psychosocial and other risk factors for cardiovascular (CV) disease. However no instrument exists that evaluates communities for these multiple environmental factors and is suitable for use across different communities, regions and countries. This report describes the design and reliability of an instrument to measure environmental determinants of CV risk factors. METHOD/PRINCIPAL FINDINGS: THE ENVIRONMENTAL PROFILE OF COMMUNITY HEALTH (EPOCH) INSTRUMENT COMPRISES TWO PARTS: (I) an assessment of the physical environment, and (II) an interviewer-administered questionnaire to collect residents' perceptions of their community. We examined the inter-rater reliability amongst 3 observers from each region of the direct observation component of the instrument (EPOCH I) in 93 rural and urban communities in 5 countries (Canada, Colombia, Brazil, China and India). Data collection using the EPOCH instrument was feasible in all communities. Reliability of the instrument was excellent (Intraclass Correlation Coefficient--ICC>0.75) for 24 of 38 items and fair to good (ICC 0.4-0.75) for 14 of 38 items. CONCLUSION: This report shows data collection with the EPOCH instrument is feasible and direct observation of community measures reliable. The EPOCH instrument will enable further research on environmental determinants of health for population studies from a broad range of settings.