Environmental Profile of a Community's Health (EPOCH): an ecometric assessment of measures of the community environment based on individual perception

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

Abstract

Background: Public 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 findings: Thirteen 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/ significance: Reliable 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.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Association between sample size of…
Figure 1. Association between sample size of respondents per community and reliabilities of community-level measures derived from EPOCH 2, overall and in urban and rural communities.
In each panel, the measures with the lowest and highest levels of interrater agreement are plotted; all other measures will lie between these two curves.

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