337Systematic social observation tool for auditing the physical, built and social health-related urban neighboourhood environment

Abstract

Abstract Background Several generic or feature-specific neighborhood audit tools have been developed. While inter/intra-observer reliability if commonly assessed, validity is not always considered. Methods A two-phase mixed-methods process was used to develop the Cyprus Neighborhood Observational Tool for urban environments (CyNOTes). Phase I: draft based on literature review, culturally adapted and content validated in focus groups with community professionals and social media ethnographic study of citizens’ experience and feasibility tested across 15 neighbourhoods. Phase II: variability in features across 45 neighbourhoods along the social disadvantage continuum and associations with census area indicators, citizens’ perceptions and health-related quality of life were assessed. Results Content validity was supported by residents’ and professionals’ descriptions of neighbourhood problems, giving rise to a 17-domain, 151-item inventory, 126 from the literature and 25 arising via Nominal Group Technique consensus and content analysis of social media posts. With good inter- and intra-observer agreement, neighborhoods with lower educational attainment scored lower in over half domains. Social gradient and clustering of adverse features observed while in neighbourhoods with adverse features residents reported lower physical and mental health-related quality of life. The social gradient was not always reflected in the perception survey. With the exception of social aspects, residents did not rate the built and physical environment favorably. “Influence and sense of control” was rated lowest while “Citizens’ voice” emerged in the inductive content analysis of residents’ lived experience. Conclusions A culturally relevant audit tool of the health-related neighborhood microenvironment was developed by assessing its content, concurrent, criterion and predictive validity. Key messages There is need for valid audit tools, independent of residents’ perceptions, for supplementary profiling of the health-related neighbourhood microenvironment Neighborhoods audits can trigger and widen conversation among local research community and policy-makers about health and place.