Abstract
Physical inactivity is the fourth leading risk factor for global mortality, with most of these deaths occurring in low and middle-income countries (LMICs) like India. Research from developed countries has consistently demonstrated associations between built environment features and physical activity levels of populations. The development of culturally sensitive and reliable measures of the built environment is a necessary first step for accurate analysis of environmental correlates of physical activity in LMICs. This study systematically adapted the Neighborhood Environment Walkability Scale (NEWS) for India and evaluated aspects of test-retest reliability of the adapted version among Indian adults. Cultural adaptation of the NEWS was conducted by Indian and international experts. Semi-structured interviews were conducted with local residents and key informants in the city of Chennai, India. At baseline, participants (N = 370; female = 47.2%) from Chennai completed the adapted NEWS-India surveys on perceived residential density, land use mix-diversity, land use mix-access, street connectivity, infrastructure and safety for walking and cycling, aesthetics, traffic safety, and safety from crime. NEWS-India was administered for a second time to consenting participants (N = 62; female = 53.2%) with a gap of 2–3 weeks between successive administrations. Qualitative findings demonstrated that built environment barriers and constraints to active commuting and physical activity behaviors intersected with social ecological systems. The adapted NEWS subscales had moderate to high test-retest reliability (ICC range 0.48–0.99). The NEWS-India demonstrated acceptable measurement properties among Indian adults and may be a useful tool for evaluation of built environment attributes in India. Further adaptation and evaluation in rural and suburban settings in India is essential to create a version that could be used throughout India.
Highlights
Non-communicable diseases (NCDs) like obesity, diabetes, and cardiovascular disease constitute a significant portion of the growing health burden across the world, of which the greatest increases are expected in low- and middle-income countries (LMICs) [1,2,3,4,5,6]
This study showed that Neighborhood Environment Walkability Scale (NEWS)-India has acceptable evidence of reliability
Evaluation, and application of NEWS-India in other Indian states could lead to evidence-based recommendations for creating communities that are designed to make people more comfortable being physically active in India
Summary
Non-communicable diseases (NCDs) like obesity, diabetes, and cardiovascular disease constitute a significant portion of the growing health burden across the world, of which the greatest increases are expected in low- and middle-income countries (LMICs) [1,2,3,4,5,6]. A LMIC with a population of 1.2 billion people and soon to be the world’s most populous country, is experiencing a NCD epidemic [7,8,9]. India has the largest diabetic population in the world, with 33 million in 2015, projected to reach 130 million by 2030 [10,11,12,13,14,15,16]. Public Health 2016, 13, 401; doi:10.3390/ijerph13040401 www.mdpi.com/journal/ijerph
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