Profiling the Built Environment
Based on the hypothesis that societal and environmental characteristics, linked to urbanisation, predict levels of chronic disease risk factors (e.g. systolic blood pressure, alcohol abuse), we are working to develop a tool to profile the built and community environment of the APCAPS villages. Our aim is to profile how changes in built environment may be associated with nutritional and epidemiological transitions.
Over the last decade, a number of built environment survey tools have been developed and used; most of these tools were applied in developed country settings although a few of them were tested in low and middle income countries (LMIC). We tested two pre-existing tools in the biggest and most urbanized village in the APCAPS study area but found these were not suitable for our setting. First, our villages are still too small and less developed than other towns and cities and several questions did not apply in our setting (i.e. vending machines and alcohol adverts). Parts of the sampling strategy were also inappropriate.
Using an iterative approach, we are currently developing our built environment tool. We began by geocoding every non-residential place (NRPs) and cohort households in all the villages. Key NRPs include food shops and outlets, other chronic disease related products, schools, parks and playgrounds and health facilities. Based on previous literature reviews, instruments and focus group discussions with villagers, we are developing a survey tool that can capture urbanisation of rural settings.
At present, we are pilot testing this tool for validity, reliability, acceptability and feasibility. We aim to roll out the instrument in all 29 villages. We will be publishing full results of the tool later in the year and once completed, data will be available for epidemiological analyses.
Examples of the built environment – fieldworkers at a chicken shop, a local vegetable market and a milk processing unit