Development of a Community Health Inclusion Index (CHII) for Measuring Accessibility and Inclusion of Physical Activity and Food Environments

The instruments currently being used to measure physical activity and healthy eating environments have not been designed to capture the needs of people with disabilities. As a result, the strategies being formulated to build healthy communities do not represent the needs of people with disabilities.  A new instrument is being developed that will provide communities with the ability to measure how well they support healthy, active living for all members of the community.  The purpose of this study is to report on the psychometric properties of the CHII. 

The content validity was established through an extensive literature review, focus groups and a set of expert panels with experts from the fields of community design, disability, nutrition, physical activity and public health.  Field testing occurred in 14 diverse communities in different geographic regions in the U.S.  Community resources were sampled by two local raters across six sectors – schools, healthcare, worksites, community institutions, food environments and the community at large.  Data analysis was conducted on the first set of completed sites (n=30) in one state (mostly urban and suburban) and examined internal consistency and inter-rater reliability.

The CHII scores, which cover the domains of physical activity, healthy eating and community design, were ranged from 0.45 (Grocery store) to 0.76 (Healthcare).   Interrater reliability was very good with percent agreement ranging from 85.2% (outdoor built environment) to 93.6% (indoor physical activity environments).  Chronbach’s Alpha ranged from 0.42 (paths subscale) to 0.79 (transit stop accessibility subscale).  

Future analysis will include communities from three other states to provide a broader range of Urban to rural settings and income diversity.  The CHII can be utilized to establish areas of need for various community health resources and to ensure community level interventions have health impacts for all members of the community.