Measuring walking within and outside the neighborhood in Chinese elders: reliability and validity

Institute of Human Performance, The University of Hong Kong, 111-113 Pokfulam Rd, SAR, Hong Kong.
BMC Public Health (Impact Factor: 2.26). 11/2011; 11(1):851. DOI: 10.1186/1471-2458-11-851
Source: PubMed


Walking is a preferred, prevalent and recommended activity for aging populations and is influenced by the neighborhood built environment. To study this influence it is necessary to differentiate whether walking occurs within or outside of the neighborhood. The Neighborhood Physical Activity Questionnaire (NPAQ) collects information on setting-specific physical activity, including walking, inside and outside one's neighborhood. While the NPAQ has shown to be a reliable measure in adults, its reliability in older adults is unknown. Additionally its validity and the influence of type of neighborhood on reliability and validity have yet to be explored.
The NPAQ walking component was adapted for Chinese speaking elders (NWQ-CS). Ninety-six Chinese elders, stratified by social economic status and neighborhood walkability, wore an accelerometer and completed a log of walks for 7 days. Following the collection of valid data the NWQ-CS was interviewer-administered. Fourteen to 20 days (average of 17 days) later the NWQ-CS was re-administered. Test-retest reliability and validity of the NWQ-CS were assessed.
Reliability and validity estimates did not differ with type of neighborhood. NWQ-CS measures of walking showed moderate to excellent reliability. Reliability was generally higher for estimates of weekly frequency than minutes of walking. Total weekly minutes of walking were moderately related to all accelerometry measures. Moderate-to-strong associations were found between the NWQ-CS and log-of-walks variables. The NWQ-CS yielded statistically significantly lower mean values of total walking, weekly minutes of walking for transportation and weekly frequency of walking for transportation outside the neighborhood than the log-of-walks.
The NWQ-CS showed measurement invariance across types of neighborhoods. It is a valid measure of walking for recreation and frequency of walking for transport. However, it may systematically underestimate the duration of walking for transport in samples that engage in high levels of this type of walking.

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Available from: Cindy Sit, Oct 01, 2015
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    • "This is not surprising since the former activities were, in general, less frequent and likely more sporadic than the latter (see Table 1). Other studies have found measures of structured and leisure-time activities to be more reliable than measures of active transport [32]. The assumption that frequency and regularity of a specific physical activity may be positively associated with the reliability of its measure is also supported by the fact that in this study, the two destinations with the highest reliability (public transport stop and food store or restaurant/café) were also the destinations most frequently visited (Tables 1 and 2). "
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    ABSTRACT: Background: Physical activity and sedentary behaviour are important contributors to adolescents' health. These behaviours may be affected by the school and neighbourhood built environments. However, current evidence on such effects is mainly limited to Western countries. The International Physical Activity and the Environment Network (IPEN)-Adolescent study aims to examine associations of the built environment with adolescent physical activity and sedentary behaviour across five continents.We report on the repeatability of measures of in-school and out-of school physical activity, plus measures of out-of-school sedentary and travel behaviours adopted by the IPEN - Adolescent study and adapted for Chinese-speaking Hong Kong adolescents participating in the international Healthy environments and active living in teenagers-(Hong Kong) [iHealt(H)] study, which is part of IPEN-Adolescent. Methods: Items gauging in-school physical activity and out-of-school physical activity, and out-of-school sedentary and travel behaviours developed for the IPEN - Adolescent study were translated from English into Chinese, adapted, and pilot tested. Sixty-eight Chinese-speaking 12-17 year old secondary school students (36 boys; 32 girls) residing in areas of Hong Kong differing in transport-related walkability were recruited. They self-completed the survey items twice, 8-16 days apart. Test-retest reliability was assessed for the whole sample and by gender using one-way random effects intra-class correlation coefficients (ICC). Test-retest reliability of items with restricted variability was assessed using percentage agreement. Results: Overall test-retest reliability of items and scales was moderate to excellent (ICC = 0.47-0.92). Items with restricted variability in responses had a high percentage agreement (92%-100%). Test-retest reliability was similar in girls and boys, with the exception of daily hours of homework (reliability higher in girls) and number of school-based sports teams or after-school physical activity classes (reliability higher in boys). Conclusions: The translated and adapted self-report measures of physical activity, sedentary and travel behaviours used in the iHealt(H) study are sufficiently reliable. Levels of reliability are comparable or slightly higher than those observed for the original measures.
    BMC Pediatrics 06/2014; 14(1):142. DOI:10.1186/1471-2431-14-142 · 1.93 Impact Factor
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    • "Participants reported the usual number of weekly minutes undertaken within an area up to 15-minute walk from home, a commonly-used operational definition of neighborhood [19,20]. The NWQ-CS measure used in this study showed moderate reliability and validity [18]. "
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    ABSTRACT: Background Walking for transport can contribute to the accrual of health-enhancing levels of physical activity in elders. Identifying destinations and environmental conditions that facilitate this type of walking has public health significance. However, most findings are limited to Western, low-density locations, while a larger proportion of the global population resides in ultra-dense Asian metropolises. We investigated relationships of within-neighborhood objectively-measured destination categories and environmental attributes with walking for transport in 484 elders from an ultra-dense metropolis (Hong Kong). Methods We estimated relationships of diversity (number of different types) and prevalence of within-neighborhood destination categories (environmental audits of 400 m buffers surrounding residential addresses) with transport-related walking (interviewer–administered questionnaire) in 484 Chinese-speaking elders able to walk unassisted and living in 32 neighborhoods stratified by socio-economic status and transport-related walkability. We examined the moderating effects of safety and pedestrian infrastructure-related neighborhood attributes on destination-walking associations. Results Participants reported on average 569 and 254 min/week of overall and within-neighborhood walking for transport, respectively. The prevalence of public transit points and diversity of recreational destinations were positively related to overall walking for transport. The presence of a health clinic/service and place of worship, higher diversity in recreational destinations, and greater prevalence of non-food retails and services, food/grocery stores, and restaurants in the neighborhood were predictive of more within-neighborhood walking for transport. Neighborhood safety-related aspects moderated the relationship of overall walking for transport with the prevalence of public transit points, this being positive only in safe locations. Similar moderating effects of safety-related attributes were observed for the relationships of within-neighborhood walking for transport with diversity of recreational and entertainment destinations. Pedestrian-infrastructure attributes acted as moderators of associations of within-neighborhood walking for transport with prevalence of commercial destination categories. Composite destinations indices consisting of destination categories related to the specific measures of walking were positively associated with walking for transport. Conclusions The availability of both non-commercial and commercial destinations may promote within-neighborhood walking for transport, while recreational facilities and public transit points may facilitate overall walking for transport. However, destination-rich areas need to also provide adequate levels of personal safety and a physically-unchallenging pedestrian network.
    International Journal of Behavioral Nutrition and Physical Activity 06/2013; 10(1):78. DOI:10.1186/1479-5868-10-78 · 4.11 Impact Factor
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    ABSTRACT: Engagement in walking for recreation can contribute to healthy aging. Although there is growing evidence that the neighborhood environment can influence walking for recreation, the amount of such evidence in relation to older adults is scarce and limited to Western low-density urban locations. Asian urban environments are typified by distinctive environmental and cultural characteristics that may yield different patterns to those observed in Western countries. Therefore, the main aim of this study was to examine associations of perceived environmental attributes with overall and within-neighborhood walking for recreation in Chinese elders (65+ years) residing in Hong Kong, an ultradense Asian metropolis. A sample of 484 elders was recruited from 32 neighborhoods stratified by socio-economic status and walkability (dwelling and intersection densities). Validated questionnaires measuring perceived neighborhood environment and weekly minutes of overall and within-neighborhood walking for recreation were interviewer administered. Results showed that the level of recreational walking was twice to four times higher than that reported in Western adults and elders. While overall walking for recreation showed a general lack of associations with perceived environmental attributes, within-neighborhood recreational walking was positively related with proximity of recreational facilities, infrastructure for walking, indoor places for walking, and presence of bridge/overpasses connecting to services. Age and educational attainment moderated the associations with several perceived environmental attributes with older and less-educated participants showing stronger associations. Traditional cultural views on the benefits of physical activity and the high accessibility of facilities and pedestrian infrastructure of Hong Kong may explain the high levels of walking. Although specific neighborhood attributes, or their perception, may influence recreational walking within the neighborhood, the compactness and public transport affordability of ultradense metropolises such as Hong Kong may make it easy for elders to compensate for the lack of favorable neighborhood attributes by walking outside the neighborhood.
    Journal of Urban Health 06/2012; 90(1). DOI:10.1007/s11524-012-9704-8 · 1.90 Impact Factor
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