A Novel Method to Evaluate the Community Built Environment Using Photographs – Environmental Profile of a Community Health (EPOCH) Photo Neighbourhood Evaluation Tool

Background Previous research has shown that environments with features that encourage walking are associated with increased physical activity. Existing methods to assess the built environment using geographical information systems (GIS) data, direct audit or large surveys of the residents face constraints, such as data availability and comparability, when used to study communities in countries in diverse parts of the world. The aim of this study was to develop a method to evaluate features of the built environment of communities using a standard set of photos. In this report we describe the method of photo collection, photo analysis instrument development and inter-rater reliability of the instrument. Methods/Principal Findings A minimum of 5 photos were taken per community in 86 communities in 5 countries according to a standard set of instructions from a designated central point of each community by researchers at each site. A standard pro forma derived from reviewing existing instruments to assess the built environment was developed and used to score the characteristics of each community. Photo sets from each community were assessed independently by three observers in the central research office according to the pro forma and the inter-rater reliability was compared by intra-class correlation (ICC). Overall 87% (53 of 60) items had an ICC of ≥0.70, 7% (4 of 60) had an ICC between 0.60 and 0.70 and 5% (3 of 60) items had an ICC ≤0.50. Conclusions/Significance Analysis of photos using a standardized protocol as described in this study offers a means to obtain reliable and reproducible information on the built environment in communities in very diverse locations around the world. The collection of the photographic data required minimal training and the analysis demonstrated high reliability for the majority of items of interest.


Introduction
Studies show the characteristics of a community's built environment are related to risk factors for chronic disease such as physical activity and obesity. To enable investigation of the relationship between community built environments and disease risk factors including genetic factors requires the development of simple and practical methods that can be used in a variety of communities to quantify community characteristics. In EPOCH (Environmental Profile of a Community's Health) we are developing methods to evaluate communities for large-scale international studies. One method of measuring the physical features of community's builtenvironment is evaluating the neighborhood design qualities visually. EPOCH Photos-Neighborhood Evaluation Tool (EP-NET) is an instrument developed to evaluate sets of photographs taken within each community.
With this tool you will be evaluating the built environment and physical features of a neighbourhood. You will be using a set of a minimum of 4 photos taken at the start point during the EPOCH community assessment walk. The photographs taken are 360 o views (back, front, right side, and left, side) from the start point and one photo taken from across the start point. You will be evaluating each item in the instrument using all the photos present in each set for each community.

Structure of the Tool
EP-NET assesses the built environment in five aspects; Places for Walking and Biking, Streets in the Neighbourhood, Safety from traffic, Neighbourhood Surroundings; Neighbourhood Satisfaction.

Q7. Grass/dirt strip is present between the sidewalk and the road:
Medium quality bicycle lanes: have signs/labels, has special markings but is not demarcated

Q12. Motor vehicle density:
Evaluate the amount of un-parked motor vehicles present on the roads. Motor vehicles include cars, buses, taxis, trucks, motorbikes or anything that has an engine. Un-parked vehicles are moving and on the main roads and not parked on side of roads away from moving traffic.

Heavy Moderate
The roads seen are occupied by many motor vehicles, heavy traffic The roads seen are occupied by some motor vehicles, medium level of traffic

Q13. Example of Vehicles:
If one vehicle is seen in more than one picture, count as '1' Q14. Parked vehicles are vehicles that are away from traffic and are parked either in a designated lot or on sides if streets and/or houses.

No median strip present Neighbourhood Surroundings
Q19-Q20. Natural features include sceneries that are not man-made but present naturally.
These can include open fields, bodies of water, mountains or hills, greenbelt/forests and deserts.
To evaluate the percentage of photographic scenes taken up by the natural features, estimate the average of how much of the natural feature is present in the entire set of photos being evaluated.

Average percentage of scenes in 4 photos taken up by natural feature: ~ 35%
Q21. Trees planted: evaluate how many trees have been planted (not present naturally) along the streets and sidewalks in the neighbourhood Q23. Graffiti are any images or words painted or marked in any manner on property.

Examples:
Q24. Litter/garbage is any waste disposed on the roads or sidewalks. Q32. Overall impression of buildings' architecture: Evaluate building and/or houses' structures vary in architectural design or have the same design. If all buildings and or houses seen in the photos have different architecture then mark 'many ranges of design'. If some buildings and/or houses are different and some are similar then mark 'some range of design'. If there is no architectural or design differences present, then mark 'all are similar in design/architecture'.

Choosing between 'Some' and 'Many'
Several questions have the option 'some' and 'many'. When evaluating, choose 'some' if the item being evaluated is present in less than 60% of all photos seen. Choose 'many' if the item is in 60% or more of all the photos seen.

Neighbourhood Satisfaction
The set of questions in this section asks your level of agreement to statements pertaining to the overall walking and biking infrastructure of neighbourhood, the safety of pedestrians in the neighbourhood, the attractiveness of buildings and homes in the neighbourhood, and the overall aesthetic appeal of the neighbourhood.