title: Validation of the COURAGE Built Environment Self-Reported Questionnaire.
abstract: The built environment (BE) impacts on people's disability and health, in terms of overweight, depression, alcohol abuse, poor self-rated health and presence of psychological symptoms; it is reasonable to assume that BE also impacts on participation levels. This paper presents the validation of the COURAGE Built Environment Self-Reported Questionnaire (CBE-SR), an instrument designed to evaluate BE in the context of health and disability. Subjects participating to COURAGE, a cross-sectional study conducted on 10,800 citizens of Poland, Finland and Spain, completed a protocol inclusive of the CBE-SR. Psychometric properties and factor structure were analysed, and factor scores created. Gender differences, differences between persons from different age groups and persons reporting the environment as facilitating, hindering or neutral were calculated. Eight items were deleted so that the final version of CBE-SR comprises 19 items. Cronbach's alpha ranged from 0.743 to 0.906, and test-retest stability was demonstrated for the majority of items. Four subscales were identified: Usability of the neighbourhood environment; Hindrance of walkable environment; Easiness of use of public buildings, places and facilities; and Risk of accidents and usability of the living place. Younger respondents reported their neighbourhood as more usable but perceived walkways as more hindering and public buildings as less easy to use; gender differences were almost inexistent. The CBE-SR is a four-scale instrument with good psychometric properties that measures the person-environment interaction. It is sensitive across age groups and is consistent with the subject's overall judgement of the degree to which the environment is facilitating or hindering.
  
  
  CONCLUSIONS
  Poor built environments have a negative impact on the level of a person's participation. However, instruments measuring the person-environment interaction are lacking. The CBE-SR is a valid and reliable instrument that researchers can use to assess the relationships between the intrinsic health state and the objective features of the environment. Understanding this relationship would provide further insight into the need of addressing the individual's functioning either by means of interventions directed to the individual or by making changes to the individual's environment.
authors.affiliation: Neurology, Public Health and Disability Unit, Neurological Institute Carlo Besta IRCCS Foundation, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Raggi
authors.forename: Rui
authors.initials: R
authors.lastname: Quintas
authors.forename: Paola
authors.initials: P
authors.lastname: Bucciarelli
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Franco
authors.forename: Alessandra
authors.initials: A
authors.lastname: Andreotti
authors.forename: Marta
authors.initials: M
authors.lastname: Miret
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Zawisza
authors.forename: Beatriz
authors.initials: B
authors.lastname: Olaya
authors.forename: Somnath
authors.initials: S
authors.lastname: Chatterji
authors.forename: Päivi
authors.initials: P
authors.lastname: Sainio
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Frisoni
authors.forename: Andrea
authors.initials: A
authors.lastname: Martinuzzi
authors.forename: Nadia
authors.initials: N
authors.lastname: Minicuci
authors.forename: Mick
authors.initials: M
authors.lastname: Power
authors.forename: Matilde
authors.initials: M
authors.lastname: Leonardi
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001107:Architectural Accessibility / Q000379:methods / Q000592:standards*; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005060:Europe; D005163:Factor Analysis, Statistical; D005260:Female; D005387:Finland; D006304:Health Status; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D011044:Poland; D011594:Psychometrics; D015203:Reproducibility of Results; D012106:Research / Q000706:statistics & numerical data; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D057566:Self Report / Q000592:standards*; D017678:Sex Distribution; D013030:Spain; D011795:Surveys and Questionnaires / Q000592:standards*; D055815:Young Adult
keywords: Aged; Built Environment; Factor Analysis; Outcome Assessment; Validation