Environmental Profile of a Community’s Health (EPOCH): An Ecometric Assessment of Measures of the Community Environment Based on Individual Perception

Daniel J Corsi,Gilles Dagenais,Scott A Lear,Sumathi Swaminathan,S V Subramanian,Clara K Chow,Salim Yusuf,Sumathy Rangarajan,Alvaro Avezum,Patricio Lopez-Jaramillo,Koon Teo,Wei Li,Martin Mckee

doi:10.1371/journal.pone.0044410

Abstract

BackgroundPublic health research has turned towards examining upstream, community-level determinants of cardiovascular disease risk factors. Objective measures of the environment, such as those derived from direct observation, and perception-based measures by residents have both been associated with health behaviours. However, current methods are generally limited to objective measures, often derived from administrative data, and few instruments have been evaluated for use in rural areas or in low-income countries. We evaluate the reliability of a quantitative tool designed to capture perceptions of community tobacco, nutrition, and social environments obtained from interviews with residents in communities in 5 countries.Methodology/ Principal FindingsThirteen measures of the community environment were developed from responses to questionnaire items from 2,360 individuals residing in 84 urban and rural communities in 5 countries (China, India, Brazil, Colombia, and Canada) in the Environmental Profile of a Community’s Health (EPOCH) study. Reliability and other properties of the community-level measures were assessed using multilevel models. High reliability (>0.80) was demonstrated for all community-level measures at the mean number of survey respondents per community (n = 28 respondents). Questionnaire items included in each scale were found to represent a common latent factor at the community level in multilevel factor analysis models.Conclusions/ SignificanceReliable measures which represent aspects of communities potentially related to cardiovascular disease (CVD)/risk factors can be obtained using feasible sample sizes. The EPOCH instrument is suitable for use in different settings to explore upstream determinants of CVD/risk factors.

Highlights

Place of residence is an important determinant of health [1]; yet the empirical evidence describing the diverse mechanisms involved remains limited
[6] In the present study, we further evaluate the ecometric properties of the Environmental Profile of a Community’s Health (EPOCH) 2 component of the instrument in terms of capturing perceptions of the community tobacco, nutrition, and social environments derived from an interview-based survey of residents from urban and rural communities in five countries
Within the context of the ‘‘PURE’’ study, an international cohort study collecting data on subjects in urban and rural areas in countries worldwide at different levels of development [14], we developed a novel instrument, the Environmental Profile of a Community’s Health (EPOCH), to evaluate communities in terms of multiple environmental factors with potential relevance to risk factors for cardiovascular disease (CVD). [6,14] The overall design of EPOCH was based on a systematic review of the relationship between environmental factors and CVD and, in particular, the existing instruments used to capture features of the environment

Summary

Introduction

Place of residence is an important determinant of health [1]; yet the empirical evidence describing the diverse mechanisms involved remains limited. We have previously described a conceptual framework which identified multiple social, legislative, and physical domains within the community environment that may have the potential to influence health behaviours and cardiovascular risk factors (e.g. smoking, diet, and physical activity) within populations. Existing methods to measure and quantify environments based on their ability to influence behaviours such as smoking have typically used one or other, and have been limited to a single domain (e.g. policy). They fail to capture completely the multiple pathways through which these influences may occur. We evaluate the reliability of a quantitative tool designed to capture perceptions of community tobacco, nutrition, and social environments obtained from interviews with residents in communities in 5 countries

Methods

Results

Conclusion