Environmental Profile of a Community's Health (EPOCH): an instrument to measure environmental determinants of cardiovascular health in five countries

Clara K Chow, Karen Lock, Manisha Madhavan, Daniel J Corsi, Anna B Gilmore, S V Subramanian, Wei Li, Sumathi Swaminathan, Patricio Lopez-Jaramillo, Alvaro Avezum, Scott A Lear, Gilles Dagenais, Koon Teo, Martin McKee, Salim Yusuf, Clara K Chow, Karen Lock, Manisha Madhavan, Daniel J Corsi, Anna B Gilmore, S V Subramanian, Wei Li, Sumathi Swaminathan, Patricio Lopez-Jaramillo, Alvaro Avezum, Scott A Lear, Gilles Dagenais, Koon Teo, Martin McKee, Salim Yusuf

Abstract

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.

Conflict of interest statement

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

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