Cross-validation of the factorial structure of the Neighborhood Environment Walkability Scale (NEWS) and its abbreviated form (NEWS-A)

Background  

The Neighborhood Environment Walkability Scale (NEWS) and its abbreviated form (NEWS-A) assess perceived environmental attributes believed to influence physical activity. A multilevel confirmatory factor analysis (MCFA) conducted on a sample from Seattle, WA showed that, at the respondent level, the factor-analyzable items of the NEWS and NEWS-A measured 11 and 10 constructs of perceived neighborhood environment, respectively. At the census blockgroup (used by the US Census Bureau as a subunit of census tracts) level, the MCFA yielded five factors for both NEWS and NEWS-A. The aim of this study was to cross-validate the individual- and blockgroup-level measurement models of the NEWS and NEWS-A in a geographical location and population different from those used in the original validation study.     

Bewegungsfreundlichkeit von Wohnumgebungen messen

Background

Internationally most studies analyzing residential environments for friendliness toward physical activity have used the ??Neighborhood Environment Walkability Scale?? (NEWS). As a German version was missing the objective of this study was to establish NEWS-Germany (NEWS-G).

Methods

The NEWS was culturally adapted and tested by cognitive debriefings (n=6) before (n=179) young adults (mean age 25.2 years) completed a computer-assisted version of NEWS-G and of a physical activity measure. Psychometric characteristics for the whole sample and intraclass correlations (ICC) based on a test-retest inquiry on NEWS-G (n=66) were calculated. Bivariate correlations of NEWS-G and physical activity were used to evaluate validity.

Results

All subscales (and most items) of NEWS-G showed acceptable psychometric characteristics and good stability (0.74??ICC??0.94) but internal consistency was low for two subscales. Some scales and items of NEWS-G showed significant correlation with physical activity.

Conclusions

The NEWS-G will be used to analyze residential environments for friendliness toward physical activity in Germany and to compare future data with available international findings. All in all more representative studies are essential to finally evaluate the reliability and validity of NEWS-G.     

Neighborhood environment profiles related to physical activity and weight status: a latent profile analysis

Background

Neighborhood built environments (BE) include combinations of co-existing stimuli influencing physical activity (PA). Dealing with numerous environmental variables and complexity presents a significant challenge. The current analysis explored whether a range of reported BE features associated with adults' physical activity produced distinct multivariate patterns, and tested whether adults' PA and body mass differed by BE profiles.

Methods

Participants (20-65 years, 48.2% female, 26% ethnic minority) were recruited between 2002 and 2005 from 32 neighborhoods from Seattle-King County, WA (N = 1287) and Baltimore, MD-Washington, DC regions (N = 912). Independent Latent Profile Analyses were conducted in each region with 11 environmental variables from the Neighborhood Environment Walkability Scale. Validity of the neighborhood profiles was examined by their relationship to PA (accelerometer-derived moderate-to-vigorous minutes/day, self-reported minutes/week of walking for transportation and leisure) and self-reported BMI using ANCOVA models.

Results

Neighborhood profiles for Seattle and Baltimore regions were visually similar, suggesting generalizability. High-walkable recreationally-dense neighborhoods differed significantly from other neighborhood types by as much as 13 MVPA minutes/day, almost 60 minutes/week of walking for transportation, and 75 min/week of leisure-time activity. Neighborhood profiles also differed significantly for BMI.

Discussion

These findings could help identify optimal patterns of environmental attributes that facilitate physical activity and improve weight status.     

Perceived Neighborhood Environmental Attributes Associated with Walking and Cycling for Transport among Adult Residents of 17 Cities in 12 Countries: The IPEN Study

Introduction

Prevalence of walking and cycling for transport is low and varies greatly across countries. Few studies have examined neighborhood perceptions related to walking and cycling for transport in different countries. Therefore, it is challenging to prioritize appropriate built-environment interventions.

Objectives

The aim of this study was to examine the strength and shape of the relationship between adults’ neighborhood perceptions and walking and cycling for transport across diverse environments.

Methods

As part of the International Physical activity and Environment Network (IPEN) adult project, self-reported data were taken from 13,745 adults (18–65 years) living in physically and socially diverse neighborhoods in 17 cities across 12 countries. Neighborhood perceptions were measured using the Neighborhood Environment Walkability Scale, and walking and cycling for transport were measured using the International Physical Activity Questionnaire–Long Form. Generalized additive mixed models were used to model walking or cycling for transport during the last seven days with neighborhood perceptions. Interactions by city were explored.

Results

Walking-for-transport outcomes were significantly associated with perceived residential density, land use mix–access, street connectivity, aesthetics, and safety. Any cycling for transport was significantly related to perceived land use mix–access, street connectivity, infrastructure, aesthetics, safety, and perceived distance to destinations. Between-city differences existed for some attributes in relation to walking or cycling for transport.

Conclusions

Many perceived environmental attributes supported both cycling and walking; however, highly walkable environments may not support cycling for transport. People appear to walk for transport despite safety concerns. These findings can guide the implementation of global health strategies.

Citation

Kerr J, Emond JA, Badland H, Reis R, Sarmiento O, Carlson J, Sallis JF, Cerin E, Cain K, Conway T, Schofield G, Macfarlane DJ, Christiansen LB, Van Dyck D, Davey R, Aguinaga-Ontoso I, Salvo D, Sugiyama T, Owen N, Mitáš J, Natarajan L. 2016. Perceived neighborhood environmental attributes associated with walking and cycling for transport among adult residents of 17 cities in 12 countries: the IPEN study. Environ Health Perspect 124:290–298; http://dx.doi.org/10.1289/ehp.1409466     

Perceptions of the food environment are associated with fast-food (not fruit-and-vegetable) consumption: findings from multi-level models

Objectives

Diets low in fruits and vegetables and/or high in fast foods are associated with obesity and chronic diseases. Such diets may relate to different aspects of neighborhood food environments. We sought to evaluate if people??s perceptions of their neighborhood food environment are associated with reported fruit-and-vegetable and fast-food consumption.

Methods

Cross-sectional analysis of a community health survey from Philadelphia, PA and four surrounding suburban counties (n?=?10,450 individuals). We used mixed-effects multi-level Poisson models, nesting individuals within neighborhoods??i.e. census tracts (n?=?991).

Results

Negative perceptions of the food environment (perceived difficulty finding fruits and vegetables, having to travel outside of one??s neighborhood to get to a supermarket, and perceived poor grocery quality) were each directly associated with fast-food consumption (incident rate ratios [IRRs] 1.31, 1.06, 1.20; p?Conclusions Perceived difficulty finding or accessing produce and high-quality groceries may support the eating of more fast food. Neighborhoods where food-environment perceptions are worst might benefit from interventions to improve availability, accessibility, and quality of healthy foods, towards shifting consumption away from fast foods.     

Association between perceived urban built environment attributes and leisure-time physical activity among adults in Hangzhou,China

BackgroundNeighborhood built environment may influence residents' physical activity, which in turn, affects their health. This study aimed to determine the associations between perceived built environment and leisure-time physical activity in Hangzhou, China.Methods1440 participants aged 25–59 were randomly selected from 30 neighborhoods in three types of administrative planning units in Hangzhou. International Physical Activity Questionnaire long form and NEWS-A were used to obtain individual-level data. The China Urban Built Environment Scan Tool was used to objectively assess the neighborhood-level built environment. Multi-level regression was used to explore the relationship between perceived built environment variables and leisure-time physical activities. Data was collected in Hangzhou from June to December in 2012, and was analyzed in May 2013.ResultsSignificant difference between neighborhood random variations in physical activity was identified (P = 0.0134); neighborhood-level differences accounted for 3.0% of the variability in leisure-time physical activity. Male residents who perceived higher scores on access to physical activity destinations reported more involvement in leisure-time physical activity. Higher scores on perception of esthetic quality, and lower on residential density were associated with more time in leisure-time walking in women.ConclusionsThe present study demonstrated that perceived urban built environment attributes significantly correlate with leisure-time physical activity in Hangzhou, China.     

Income disparities in perceived neighborhood built and social environment attributes

The present study explored whether perceived neighborhood environmental attributes associated with physical activity differ by neighborhood income. Adults aged 20–65 years (n=2199; 48% female; mean age=45 years; 26% ethnic minority) were recruited from 32 neighborhoods from the Seattle, WA and Baltimore, MD regions that varied in objectively measured walkability and neighborhood income. Perceived built and social environment variables were assessed with the Neighborhood Environment Walkability Scale. There were neighborhood income disparities on 10 of 15 variables. Residents from high-income neighborhoods reported more favorable esthetics, pedestrian/biking facilities, safety from traffic, safety from crime, and access to recreation facilities than residents of low-income areas (all p's <0.001). Low-income neighborhoods may lack amenities and safety attributes that can facilitate high levels of physical activity for both transportation and recreation purposes.     

Factor analytic and item response theory evaluation of the Penn State Worry Questionnaire in women with cancer

Purpose

Cancer survivors frequently experience worry about a variety of topics, including fear of recurrence. However, general measures of worry still require examination of reliability for this vulnerable population. This study utilized modern psychometric methods to examine the reliability of a worry measure in women with breast or gynecologic cancer.

Methods

Women with cancer (n = 332) completed the 16-item Penn State Worry Questionnaire (PSWQ), which has an abbreviated 8-item version (PSWQ-A). Categorical confirmatory factor analysis (CCFA) was used to determine the factor structure and item response theory (IRT) was used to examine score reliability.

Results

CCFA supported a two-factor structure with 11 positively worded items and the 5 negatively worded items loading on different factors. IRT analysis of the 11 positively worded items showed that each was contributing meaningful information to the overall scores. The 11 positively worded items and the PSWQ-A produced the most reliable scores for levels of worry ranging from one θ below to two θ above the mean.

Conclusions

The 11 positively worded items of the PSWQ and the 8-item PSWQ-A were suitable for use in cancer patients while the full PSWQ was unsuitable due to inclusion of the negatively worded items. Future research should consider measuring worry when examining distress in cancer survivors.     

Oral cholera vaccine use in Zanzibar: socioeconomic and behavioural features affecting demand and acceptance

Background

Built environment attributes are recognized as being important contributors to physical activity (PA) engagement and body size in adults and children. However, much of the existing research in this emergent public health field is hindered by methodological limitations, including: population and site homogeneity, reliance on self-report measures, aggregated measures of PA, and inadequate statistical modeling. As an integral component of multi-country collaborative research, the Understanding the Relationship between Activity and Neighbourhoods (URBAN) Study seeks to overcome these limitations by determining the strengths of association between detailed measures of the neighborhood built environment with PA levels across multiple domains and body size measures in adults and children. This article outlines the research protocol developed for the URBAN Study.

Methods and design

The URBAN Study is a multi-centered, stratified, cross-sectional research design, collecting data across four New Zealand cities. Within each city, 12 neighborhoods were identified and selected for investigation based on higher or lower walkability and Māori demographic attributes. Neighborhoods were selected to ensure equal representation of these characteristics. Within each selected neighborhood, 42 households are being randomly selected and an adult and child (where possible) recruited into the study. Data collection includes: objective and self-reported PA engagement, neighborhood perceptions, demographics, and body size measures. The study was designed to recruit approximately 2,000 adults and 250 children into the project. Other aspects of the study include photovoice, which is a qualitative assessment of built environment features associated with PA engagement, an audit of the neighborhood streetscape environment, and an individualized neighborhood walkability profile centered on each participant's residential address. Multilevel modeling will be used to examine the individual-level and neighborhood-level relationships with PA engagement and body size.

Discussion

The URBAN Study is applying a novel scientifically robust research design to provide urgently needed epidemiological information regarding the associations between the built environment and health outcomes. The findings will contribute to a larger, international initiative in which similar neighborhood selection and PA measurement procedures are utilized across eight countries. Accordingly, this study directly addresses the international priority issues of increasing PA engagement and decreasing obesity levels.     

Capturing exposure in environmental health research: challenges and opportunities of different activity space models

Background

The built environment health promotion has attracted notable attention across a wide spectrum of health-related research over the past decade. However, the results about the contextual effects on health and PA are highly heterogeneous. The discrepancies between the results can potentially be partly explained by the diverse use of different spatial units of analysis in assessing individuals’ exposure to various environment characteristics. This study investigated whether different residential and activity space units of analysis yield distinct results regarding the association between the built environment and health. In addition, this study examines the challenges and opportunities of the different spatial units of analysis for environmental health-related research.

Methods

Two common residential units of analysis and two novel activity space models were used to examine older adults’ wellbeing in relation to the built environment features in the Helsinki Metropolitan Area, Finland. An administrative unit, 500 m residential buffer, home range model and individualized residential exposure model were used to assess the associations between the built environment and wellbeing of respondent’s (n?=?844).

Results

All four different spatial units of analysis yield distinct results regarding the associations between the built environment characteristics and wellbeing. A positive association between green space and health was found only when exposure was assessed with individualized residential exposure model. Walkability index and the length of pedestrian and bicycle roads were found to positively correlate with perceived wellbeing measures only with a home range model. Additionally, all units of analysis differed from each other in terms of size, shape, and how they capture different contextual measures.

Conclusions

The results show that different spatial units of analysis result in considerably different measurements of built environment. In turn, the differences derived from the use of different spatial units seem to considerably affect the associations between environment characteristics and wellbeing measures. Although it is not easy to argue about the correctness of these measurements, what is evident is that they can reveal different wellbeing outcomes. While some methods are especially usable to determine the availability of environmental opportunities that promote active travel and the related health outcomes, others can provide us with insight into the mechanisms how the actual exposure to green structure can enhance wellbeing.

     

Using the ICF’s environmental factors framework to develop an item bank measuring built and natural environmental features affecting persons with disabilities

Objectives

To develop a measure of natural environment and human-made change features (Chapter 2 of the international classification of functioning, disability, and health) and evaluate the influence of perceived barriers on health-related quality of life.

Methods

A sample of 570 adults with stroke, spinal cord injury, and traumatic brain injury residing in community settings reported their functioning in home, outdoor, and community settings (mean age = 47.0 years, SD = 16.1). They rated 18 items with a 5-point rating scale to describe the influence of barriers to moving around, seeing objects, hearing sounds, hearing conversations, feeling safe, and regulating temperature and indicated whether any difficulties were due to environmental features. We used Rasch analysis to identify misfitting items and evaluate differential item functioning (DIF) across impairment groups. We computed correlations between barriers and patient-reported outcomes measurement information system (PROMIS) social domain measures and community participation indicators (CPI) measures.

Results

The 18 items demonstrated person reliability of .70, discriminating nearly three levels of barriers. All items fit the Rasch model; impairment-related DIF was negligible. Ceiling effects were negligible, but 25 % of the respondents were at the floor, indicating that they did not experience barriers that they attributed to the built and natural environment. As anticipated, barriers correlated moderately with PROMIS and CPI variables, suggesting that although this new item bank measures a construct that is related to participation and health-related quality of life, it also captures something unique. Known-groups validity was supported by wheelchair users reporting a higher level of barriers than did ambulatory respondents.

Conclusions

Preliminary evidence supports the reliability and validity of this new measure of barriers to the built and natural environment. This measure allows investigators and clinicians to measure perceptions of the natural environment and human-made changes, providing information that can guide interventions to reduce barriers. Moderate relationships between barriers and PROMIS and CPI variables provide support for the measurement and theory of environmental influences on social health and participation.

     

“Do you see what I see?” – Correlates of multidimensional measures of neighborhood types and perceived physical activity–related neighborhood barriers and facilitators for urban youth

ObjectivesTo classify types of neighborhood environment and to examine the gender-specific cross-sectional associations between these neighborhood types and adolescents' perceptions of physical activity–related neighborhood barriers and facilitators.MethodsThis cross-sectional study was conducted with a sample of 350 high school students in Baltimore, Maryland, in 2006. Participants completed the Neighborhood Environment Walkability Scale (NEWS). Objectively GIS-measured attributes of urban form came from various sources. Classification of built environment/neighborhood types was achieved by factor analysis and cluster analysis.ResultsFour neighborhood types were identified: (1) arterial development; (2) inner-city area; (3) suburban residential; and (4) central business district. Girls who lived in suburban residential areas were less likely than their central business district counterparts to perceive the protective effects of crosswalks and pedestrian traffic signals. Girls living in inner-city neighborhoods were more likely than their central business district counterparts to perceive the traffic as being slow. Boys' perceptions of their neighborhood did not vary by neighborhood pattern.ConclusionsGirls appear to be more sensitive to their environment and perceive more physical activity–related built environment barriers compared to boys. Efforts to overcome physical activity barriers salient for adolescent girls should be tailored to the type of neighborhood.     

Association between Perceived Neighborhood Environment and Walking among Adults in 4 Cities in Japan

Background

Recent research highlights the importance of environment as a determinant of physical activity; however, evidence among Japanese is sparse. The aim of this study was to examine the association between perceived neighborhood environment and neighborhood walking for multiple purposes among Japanese.

Methods

We conducted a population-based, cross-sectional study of 1461 Japanese adults (age: 48.2 ± 14.1 years, men: 44.8%). Neighborhood environment and walking were assessed by a validated questionnaire. The odds ratio of active walkers was calculated in relation to environmental characteristics after adjustment for age, sex, and other potential confounders.

Results

Participants were more likely to walk when they perceived that there was high residential density (odds ratio, 1.47; 95% confidence interval, 1.11–1.96), fair land use mix–diversity (1.37, 1.04–1.81), good walking/cycling facilities (1.56, 1.19–2.04), and attractive aesthetics (1.49, 1.14–1.95). Environmental factors associated with walking differed with respect to the purpose for walking. The environmental characteristics associated with walking for daily errands and with walking for commuting were similar, and included residential density and land use mix. Walking for leisure was associated with walking/cycling facilities, aesthetics, and traffic safety. Stratified analyses showed some sex-specific associations. Among women, there was an unexpected inverse association of leisure walking with both residential density and land use mix–diversity.

Conclusions

The association between neighborhood environment and walking differed by walking purpose. The results were generally consistent with those of studies conducted in Western countries, except for the association of high residential density and good land use mix–diversity with less leisure walking in women. These results suggest possible targets for environmental interventions to promote walking.Key words: active transport, neighborhood environment, physical activity, policy, walking     

Validity and repeatability of the EPIC physical activity questionnaire: a validation study using accelerometers as an objective measure

Background

Few measures exist to measure the overall home environment for its ability to support physical activity (PA) and healthy eating in overweight children. The purpose of this study was to develop and test the reliability and validity of such a measure.

Methods

The Home Environment Survey (HES) was developed to reflect availability, accessibility, parental role modelling, and parental policies related to PA resources, fruits and vegetables (F&V), and sugar sweetened drinks and snacks (SS). Parents of overweight children (n = 219) completed the HES and concurrent behavioural assessments. Children completed the Block Kids survey and wore an accelerometer for one week. A subset of parents (n = 156) completed the HES a second time to determine test-retest reliability. Finally, 41 parent dyads living in the same home (n = 41) completed the survey to determine inter-rater reliability. Initial psychometric analyses were completed to trim items from the measure based on lack of variability in responses, moderate or higher item to scale correlation, or contribution to strong internal consistency. Inter-rater and test-retest reliability were completed using intraclass correlation coefficients. Validity was assessed using Pearson correlations between the HES scores and child and parent nutrition and PA.

Results

Eight items were removed and acceptable internal consistency was documented for all scales (α = .66–84) with the exception of the F&V accessibility. The F&V accessibility was reduced to a single item because the other two items did not meet reliability standards. Test-retest reliability was high (r > .75) for all scales. Inter-rater reliability varied across scales (r = .22–.89). PA accessibility, parent role modelling, and parental policies were all related significantly to child (r = .14–.21) and parent (r = .15–.31) PA. Similarly, availability of F&V and SS, parental role modelling, and parental policies were related to child (r = .14–36) and parent (r = .15–26) eating habits.

Conclusion

The HES shows promise as a potentially valid and reliable assessment of the physical and social home environment related to a child's physical activity and eating habits.     

The food environment and dietary intake: demonstrating a method for GIS-mapping and policy-relevant research

Aims

The aims of this paper are (1) to assess if perceptions of the food environment are associated with select dietary intake by neighborhood, and (2) to map neighborhood-specific findings, demonstrating a method for policy-relevant research.

Methods

Using pre-collected data from a Philadelphia, PA community health survey, we aggregated individual-level data (n?=?4,434 respondents) to neighborhoods (n?=?381 census tracts), adjusting for conceptually-relevant socio-demographic factors. We estimated Spearman correlations between multivariable adjusted food-environment perceptions (perceived produce availability, supermarket accessibility, grocery quality) and select dietary intake (reported fruit-and-vegetable and fast-food consumption), and mapped variables by neighborhood using geographic information systems (GIS).

Results

Difficulty finding fruits and vegetables, having to travel outside of one’s neighborhood to get to a supermarket, and poor grocery quality were each directly correlated with fast-food intake (rho?=?0.21, 0.34, 0.64 respectively; p values <0.001); and inversely correlated with fruit-and-vegetable intake (rho?=?–0.35, –0.54, –0.56 respectively; p values <0.001). Maps identified neighborhoods within the city with the worst food-environment perceptions and poorest dietary intakes.

Conclusion

Negative perceptions of the food environment were strongly correlated with less-healthy eating in neighborhoods. Maps showed the geographic areas of greatest concern. Our findings demonstrate a method that might be used prospectively in public health for policy planning (e.g. to identify neighborhoods most in need), or retrospectively for policy assessment (e.g. to identify changes in neighborhoods after policy implementation).     

Die Universität – ein kohärentes Setting?

Background

This study examined the sense of coherence (SOC) of students, especially for those in the university setting, as well as their perceived quality of life.

Methods

A questionnaire that assesses SOC of university staff was adapted for students; 191 students at an Austrian university answered these items and questions regarding their quality of life.

Results

Confirmatory factor analysis supported the three-dimensionality of the“Students’ SoC” scale, which showed significant effects regarding the students’ quality of life.

Conclusion

The manageability and meaningfulness of university events is associated with respondents’ well-being. Health promotion should implement interventions that ensure well-defined structures and more codetermination and participation for students.     

Do Relationships Between Environmental Attributes and Recreational Walking Vary According to Area-Level Socioeconomic Status?

Residents of areas with lower socioeconomic status (SES) are known to be less physically active during leisure time. Neighborhood walkability has been shown to be related to recreational walking equally in low and high SES areas. This cross-sectional study tested whether associations of specific environmental attributes, measured objectively and subjectively, with walking for recreation were moderated by area-level SES. The data of the North West Adelaide Health Study collected in 2007 (n = 1500, mean age 57) were used. Self-reported walking frequency was the outcome of the study. Environmental exposure measures included objectively measured walkability components (residential density, intersection density, land use mix, and net retail area ratio) and perceived attributes (access to destinations, neighborhood esthetics, walking infrastructure, traffic/barriers, and crime safety). Participants’ suburbs were categorized into low and high SES areas using an indicator of socioeconomic disadvantage. Low SES areas had lower scores in residential density, neighborhood esthetics, walking infrastructure, traffic/barriers, and crime safety. Recreational walking was associated with residential density, access to destinations, esthetics, traffic/barriers, and crime safety. Effect modification was observed for two attributes (out of nine): residential density was associated with walking only in low SES areas, while walking infrastructure was associated with walking only in high SES areas. The associations of neighborhood environmental attributes with recreational walking were largely consistent across SES groups. However, low SES areas were disadvantaged in most perceived environmental attributes related to recreational walking. Improving such attributes in low SES neighborhoods may help close socioeconomic disparities in leisure time physical activity.Keyword: Physical activity, Neighborhood environment, Walkability, Inequality, Effect modification     

Feasibility and reliability of the mini nutritional assessment (MNA) in older adults with intellectual disabilities

Objective

Feasibility and reliability of the Mini Nutritional Assessment (MNA) in older adults with intellectual disabilities (ID).

Design

Instrument development.

Setting

Three care providers for people with ID.

Participants

48 persons aged 50 years and over with borderline to profound ID and their professional caregivers.

Measurements

The MNA was performed by means of interviews with participants (N = 12) and caregivers (N = 48) and physical assessments of participants (N = 47). Aspects of feasibility: completion of interview, difficulty of answering interview items, duration of interview and completion of physical assessment. Aspects of reliability: inter-observer reliability between caregivers and between participants and caregivers, test-retest reliability and internal consistency. For inter-observer and test-retest reliability, intraclass correlation coefficients (ICC) were calculated, and for internal consistency Chronbach??s alpha.

Results

All participants and caregivers completed the interview part. For 7 out of 12 personally interviewed participants and none of the caregivers, at least 3 out of 15 questions were difficult to answer. Mean duration of the interview was 7 minutes in participants and 4 minutes in caregivers. Physical assessment was successfully performed in 40 participants (85.1%). In the remaining 7 participants (14.9%) missing values were retrieved from the medical records. ICCs (95% confidence interval) for test-retest and inter-observer reliability between caregivers were good, 0.85 (0.72?C0.92) and 0.86 (0.74?C0.92) respectively, but ICC for inter-observer reliability between caregivers and persons with ID was low, 0.03 (?0.51 ?0.59). Internal consistency was 0.61.

Conclusion

The MNA is feasible and reliable for older people with ID. Interview data can be reliably obtained through caregivers, but not through people with ID.     

Getting serious about test–retest reliability: a critique of retest research and some recommendations

Purpose

To focus attention on the need for rigorous and carefully designed test–retest reliability assessments for new patient-reported outcomes and to encourage retest researchers to be thoughtful, ambitious, and creative in their retest efforts.

Methods

The paper outlines key challenges that confront retest researchers, calls attention to some limitations in meeting those challenges, and describes some strategies to improve retest research.

Results

Modest retest coefficients are often reported as acceptable, and many important decisions—such as the retest interval—appear not to be evidence-based. Retest assessments are seldom undertaken before a measure has been finalized, which rules out using retest data to select strong, reproducible items.

Conclusions

Strategies for improving retest research include seeking input from patients or experts regarding the stability of the construct to support decisions about the retest interval, analyzing item-level retest data to identify items to revise or discard, establishing a priori standards of acceptability for reliability coefficients, using large, heterogeneous, and representative retest samples and collecting follow-up data to better understand consistent and inconsistent responses over time.     

Brushing behavior among young adolescents: does perceived severity matter

Background

Oral health is a basis for general health and well-being and affects physical and psychological aspects of the human life. The aim of this study was to determine the power of the health belief model in general and the role of perceived severity and its components in particular in predicting tooth brushing behavior among young adolescents.

Methods

This was a cross sectional study of a sample of female students grade four in Rasht (a metropolitan in north Iran) in 2012. A systematic random sampling method was applied to recruit students. They were asked to respond to a designed questionnaire containing items on brushing behavior based on the health belief model. In this study for the first time perceived severity and perceived barriers were divided into two parts, perceived subjective and objective severity and perceived physical and psychological barriers and were treated as independent variables. Logistic regression analysis was performed in order to identify the variables that predict the desirable behavior (brushing twice a day or more).

Results

In all 265 female students were entered into the study. Of these, only 17.4% reported that they were brushing at least twice a day (desirable behavior). The results obtained from the logistic regression analysis indicated that perceived objective severity (OR?=?0.37, 95% CI?=?0.21- 0.66, P?=?0.001) and feeling less perceived psychological barriers (OR?=?2.60, 95% CI?=?1.50- 4.52, P?=?0.001) were the significant predicting factors for brushing twice a day.

Conclusion

The findings suggest that perceived objective severity and perceived psychological barriers play important role in adapting a desirable health behavior among young adolescents.