Building Health Empowerment Zones for People with Disabilities: Obesity and the Built Environment

There are dozens of environmental audit instruments that measure walkability and bikability of neighborhoods but none measure access to fitness and recreation areas and grocery stores for people with mobility disabilities who use wheelchairs as their primary mode of ambulation. We developed a brief outdoor environmental accessibility tool for people with mobility disabilities called the Survey of Community Accessibility to Nutrition, Fitness and Recreation Environments (SCANFREE). The aim of SCANFREE is to measure community access to the built environment with respect to outdoor fitness and recreation areas and grocery stores that sell healthier foods. The SCANFREE consists of two major sections: (1) built environment accessibility, and (2) public transportation access. Items were adapted from previously validated environmental accessibility surveys. After an internal review of item content, an expert panel in disability and accessibility rated in two separate reviews the accessibility relevance of each item on a 5-point scale (1 "not relevant", 5 "very relevant"). Content Validity Ratios (CVR) were calculated based on these ratings. A CVR of Ан .75 was considered statistically significant. Two rounds of reviews resulted in significant CVRs for 28 of 99 items (p<.05). Among the 17 transportation items, CVRs were significant for 13 items (p<.05). These findings support the content validity of the SCANFREE as a brief audit instrument for neighborhood rollability using a relatively smaller number of survey items compared to previously validated instruments. Future field work within a larger NIH trial is currently underway to evaluate the construct validity of the SCANFREE (Grant #R01HD052891).