title: A novel method to evaluate the community built environment using photographs--Environmental Profile of a Community Health (EPOCH) photo neighbourhood evaluation tool.
abstract: 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.
  
  
  RESULTS
  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
  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.
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada; The George Institute for Global Health and Westmead Hospital Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Clara K
authors.initials: CK
authors.lastname: Chow
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada; Harvard Center for Population & Development Studies, Cambridge, MA, United States of America.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Corsi
authors.affiliation: European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Karen
authors.initials: K
authors.lastname: Lock
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Manisha
authors.initials: M
authors.lastname: Madhavan
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Pam
authors.initials: P
authors.lastname: Mackie
authors.affiliation: Cardiovascular Institute & Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.affiliation: Cardiovascular Institute & Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Sun
authors.initials: S
authors.lastname: Yi
authors.affiliation: Cardiovascular Institute & Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Wang
authors.affiliation: St. John's Research Institute, St John's National Academy of Health Sciences, Bangalore, Karnataka, India.
authors.forename: Sumathi
authors.initials: S
authors.lastname: Swaminathan
authors.affiliation: Research Direction, Fundacion Oftalmologica de Santander-Clinica Carlos Arila Lulle and Medical School, Universidad de Santander, Bucaramanga, Colombia.
authors.forename: Patricio
authors.initials: P
authors.lastname: Lopez-Jaramillo
authors.affiliation: Research Direction, Fundacion Oftalmologica de Santander-Clinica Carlos Arila Lulle and Medical School, Universidad de Santander, Bucaramanga, Colombia.
authors.forename: Diego
authors.initials: D
authors.lastname: Gomez-Arbelaez
authors.affiliation: Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Avezum
authors.affiliation: Faculty of Health Sciences, Simon Fraser University and Division of Cardiology, Providence Health Care, Vancouver, B.C., Canada.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Lear
authors.affiliation: Institut universitaire de cardiologie et de pneumologie de Québec (Université Laval), Quebec City, Quebec, Canada.
authors.forename: Gilles
authors.initials: G
authors.lastname: Dagenais
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Koon
authors.initials: K
authors.lastname: Teo
authors.affiliation: European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D004779:Environment Design; D006801:Humans; D011634:Public Health; D012111:Residence Characteristics; D012931:Social Environment; D011795:Surveys and Questionnaires; D016138:Walking