Neurology, Public Health and Disability Unit, Neurological Institute Carlo Besta IRCCS Foundation, Milan, Italy.
Clin Psychol Psychother. 2014 May-Jun;21(3):215-26. doi: 10.1002/cpp.1859. Epub 2013 Jul 16.
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.
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.
建筑环境（BE）会影响人们的残疾和健康状况，包括超重、抑郁、酗酒、自我评估健康状况不佳和存在心理症状；因此，可以合理地假设 BE 也会影响参与度。本文介绍了 COURAGE 建筑环境自我报告问卷（CBE-SR）的验证，该问卷是为评估健康和残疾背景下的 BE 而设计的。参与 COURAGE 的受试者完成了一份包括 CBE-SR 的方案，COURAGE 是一项在波兰、芬兰和西班牙的 10800 名公民中进行的横断面研究。对心理测量学特性和因素结构进行了分析，并创建了因素得分。计算了不同性别、不同年龄组人群以及报告环境促进、阻碍或中性的人群之间的差异。删除了 8 个项目，使 CBE-SR 的最终版本包含 19 个项目。Cronbach 的 alpha 系数范围为 0.743 至 0.906，大多数项目的测试重测稳定性得到了证明。确定了四个子量表：邻里环境的可用性；步行环境的阻碍；公共建筑、场所和设施的易用性；事故风险和居住场所的可用性。年轻的受访者报告说他们的邻里更可用，但认为步行道更有阻碍，公共建筑更难使用；性别差异几乎不存在。CBE-SR 是一种具有良好心理测量学特性的四尺度工具，可衡量人与环境的相互作用。它在不同年龄组中都具有敏感性，并且与受试者对环境促进或阻碍程度的总体判断一致。
较差的建筑环境会对一个人的参与程度产生负面影响。然而，衡量人与环境相互作用的工具却很缺乏。CBE-SR 是一种有效且可靠的工具，研究人员可以用它来评估个人内在健康状况与环境客观特征之间的关系。了解这种关系将进一步深入了解是否需要通过针对个人的干预措施或通过改变个人的环境来解决个人的功能问题。
