How do our environments affect our minds?

Neuroscience reveals how building design shapes our behavioral, brain, and body responses.

Residential greenness and hair cortisol levels during the first trimester of pregnancy.

BACKGROUND AND AIM: Studies have shown that increased maternal cortisol level is associated with child adverse health outcomes. Hair cortisol (HC) is suitable for assessing long-term circulating cortisol concentration. Only two previous studies reported beneficial associations between cortisol and residential greenness during pregnancy and no study focused on the first trimester. Our aim was to evaluate the association between residential greenness and first trimester HC levels among pregnant women in Israel. METHODS: Women were recruited during second and third trimesters. Hair samples were collected from the scalp and retrospective HC levels during the first trimester were quantified for 217 women. HC levels were natural log transformed and outliers were excluded. Based on geocoded birth address, small area sociodemographic status (SES) and mean residential surrounding greenness were calculated using high-resolution satellite-based Normalised Difference Vegetation Index (NDVI) data at 100, 300 and 500-m buffers in a cross-sectional approach. In addition, longitudinal exposure to mean greenness during a week preconception and during the first trimester were calculated. Missing covariates were imputed and linearity of the associations were evaluated. Generalized linear models were used to estimate the crude and adjusted associations controlled for the relevant covariates. RESULTS: After exclusion of outliers, for 211 women, crude and adjusted beneficial associations between exposure to higher mean NDVI and HC levels were observed for all the exposure measures. An increase in 1 interquartile range of greenness (100 m buffer) was associated with a statistically significant lower estimated natural log mean HC level (-0.27 95% CI: -0.44; -0.11). The associations were robust to adjustment for covariates. The findings were consistent for different buffers, for the longitudinal approach, when all observations were included in the analysis and slightly stronger associations were observed for women with addresses geocoded at the home or street level. For most of the exposure measures, stronger associations were observed among those of lower sociodemographic status. CONCLUSION: Our findings that more greenness associated with reduced maternal cortisol levels measured in the hair during the first trimester, could have substantial implications for urban planners and public health professional. If our observations will be replicated, it may present a useful avenue for public-health intervention to promote health through the provision of greenness exposure during early pregnancy, specifically to disadvantage populations.

Developing a Subjective Evaluation Scale for Assessing the Built Environments of China's Hygienic City Initiative.

OBJECTIVE: To develop a preliminary subjective evaluation scale for assessing the built environments of China's Hygienic City Initiative and to evaluate its reliability and validity. METHODS: The initial items of the scale were determined based on a review of policy documents and consultations with experts. The final items of the scale were confirmed through individual interviews with residents combined with the discretetrend method, critical ratio method, correlation coefficient method, and factor analysis method. Then, the dimensions of the scale were determined using exploratory factor analysis (EFA). The Cronbach's α coefficient, split-half reliability coefficient, and confirmatory factor analysis (CFA) were used to assess the reliability and validity of the scale. RESULTS: A scale containing five dimensions with 22 items was established, including urban lifestyle, governance, basic functions, environmental sanitation, and amenities. The Cronbach's α coefficient of the scale was 0.876, and the split-half reliability coefficient was 0.796. The CFA results indicate that each inspection level was within the standard limit. CONCLUSION: The preliminarily subjective evaluation scale for assessing the built environments of China's Hygienic City Initiative demonstrates a high level of reliability and validity. Additional empirical studies should be carried out to further verify the value of the scale in terms of practical application.

Does the built environment have independent obesogenic power? Urban form and trajectories of weight gain.

OBJECTIVE: To determine whether selected features of the built environment can predict weight gain in a large longitudinal cohort of adults. METHODS: Weight trajectories over a 5-year period were obtained from electronic health records for 115,260 insured patients aged 18-64 years in the Kaiser Permanente Washington health care system. Home addresses were geocoded using ArcGIS. Built environment variables were population, residential unit, and road intersection densities captured using Euclidean-based SmartMaps at 800-m buffers. Counts of area supermarkets and fast food restaurants were obtained using network-based SmartMaps at 1600, and 5000-m buffers. Property values were a measure of socioeconomic status. Linear mixed effects models tested whether built environment variables at baseline were associated with long-term weight gain, adjusting for sex, age, race/ethnicity, Medicaid insurance, body weight, and residential property values. RESULTS: Built environment variables at baseline were associated with differences in baseline obesity prevalence and body mass index but had limited impact on weight trajectories. Mean weight gain for the full cohort was 0.06 kg at 1 year (95% CI: 0.03, 0.10); 0.64 kg at 3 years (95% CI: 0.59, 0.68), and 0.95 kg at 5 years (95% CI: 0.90, 1.00). In adjusted regression models, the top tertile of density metrics and frequency counts were associated with lower weight gain at 5-years follow-up compared to the bottom tertiles, though the mean differences in weight change for each follow-up year (1, 3, and 5) did not exceed 0.5 kg. CONCLUSIONS: Built environment variables that were associated with higher obesity prevalence at baseline had limited independent obesogenic power with respect to weight gain over time. Residential unit density had the strongest negative association with weight gain. Future work on the influence of built environment variables on health should also examine social context, including residential segregation and residential mobility.

Perceived built environment and type 2 diabetes incidence: Exploring potential mediating pathways through physical and mental health, and behavioural factors in a longitudinal study.

AIMS: The evidence on the pathways through which the built environment may influence type 2 diabetes (T2D) risk is limited. This study explored whether behavioural, physical and mental health factors mediate the associations between perceived built environment and T2D. METHODS: Longitudinal data on 36,224 participants aged ≥45 years (The Sax Institute's 45 and Up Study) was analysed. Causal mediation analysis that uses the counterfactual approach to decompose the total effect into direct and indirect effects was performed. RESULTS: The results showed that physical activity, recreational walking, and BMI mediated around 6%, 11%, and 30%, respectively, of the association between perceived lack of access to local amenities and T2D incidence. Physical activity (4.8% for day-time crime), recreational walking (2.3% for day-time crime), psychological distress (5.2% for day-time, 3.7% for night-time crime), and BMI (29.6% for day-time crime, 17.4% for night-time crime) also partially mediated the effect of perceived crime. Mediated effects appeared larger at wave 3 than the same wave 2 mediators. CONCLUSIONS: The findings demonstrate that physical activity, psychological distress, and BMI mediate the pathways between the built environment and T2D. Policies aimed to bring amenities closer to homes, prevent crime, and address mental health may help reduce T2D risk.

Perceived built environment, health-related quality of life and health care utilization.

Previous research has shown that the built environment plays a crucial role for health-related quality of life (HRQoL) and health care utilization. But, there is limited evidence on the independence of this association from lifestyle and social environment. The objective of this cross-sectional study was to investigate these associations, independent of the social environment, physical activity and body mass index (BMI). We used data from the third follow-up of the Swiss study on Air Pollution and Lung and Heart diseases In Adults (SAPALDIA), a population based cohort with associated biobank. Covariate adjusted multiple quantile and polytomous logistic regressions were performed to test associations of variables describing the perceived built environment with HRQoL and health care utilization. Higher HRQoL and less health care utilization were associated with less reported transportation noise annoyance. Higher HRQoL was also associated with greater satisfaction with the living environment and more perceived access to greenspaces. These results were independent of the social environment (living alone and social engagement) and lifestyle (physical activity level and BMI). This study provides further evidence that the built environment should be designed to integrate living and green spaces but separate living and traffic spaces in order to improve health and wellbeing and potentially save health care costs.

Neighborhood Built Environment and Late-Life Depression: A Multilevel Path Analysis in a Chinese Society.

OBJECTIVES: Neighborhood built environments (BEs) are increasingly recognized as being associated with late-life depression. However, their pathways are still understudied. This study investigates the mediating effects of physical and social activities (PA and SA) and functional ability (FA) in the relationships between BEs and late-life depression. METHODS: We conducted a cross-sectional analysis with data from 2,081 community-dwellers aged 65 years and older in Hong Kong in 2014. Two road-network-based service area buffers (200- and 500-m buffers) adjusted by terrain and slope from participants' residences were created to define the scope of neighborhoods. BEs comprised population density in District Council Constituency Areas, urban greenness, land-use diversity, and neighborhood facilities within 200- and 500-m buffers. Multilevel path analysis models were used. RESULTS: More urban greenness within both buffers and more commercial facilities within a 500-m buffer were directly associated with fewer depressive symptoms. SA mediated the relationship between the number of community facilities and depressive symptoms within a 200-m buffer. Neighborhood urban greenness and the number of commercial facilities had indirect associations on depressive symptoms within a 500-m buffer, which were mediated by FA. DISCUSSION: Our findings have implications for the ecological model of aging. The mediating effects of SA and FA underscore the importance of promoting active social lifestyles and maintaining FA for older adults' mental health in high-density cities. Policy implications on how to build age-friendly communities are discussed.

Is the perceived neighborhood built environment associated with domain-specific physical activity in Latin American adults? An eight-country observational study.

BACKGROUND: Characteristics of the neighborhood built environment are associated with physical activity (PA). However, few studies with representative samples have examined environmental correlates of domain-specific PA in Latin America. We examined the associations of the perceived neighborhood built environment with domain-specific PA in a large sample of adults from eight Latin American countries. METHODS: This study examined data from 8185 adults (aged 18-65 years) from eight Latin American countries. The Neighbourhood Environment Walkability Survey - Abbreviated (NEWS-A) scale was used to assess perceptions of land use mix-diversity, land use mix-access, street connectivity, walking/cycling facilities, aesthetics, safety from traffic, and safety from crime. Perceived proximity from home to public open spaces (metropolitan parks, playgrounds, public squares) and to shopping centers was also measured. Transport-related and leisure-time PA were assessed using the long form of the International Physical Activity Questionnaire. Both logistic and linear regression models were estimated on pooled data. RESULTS: Perceptions of higher land use mix-access (OR: 1.40; 95% CI: 1.22,1.61), the existence of many alternative routes in the neighbourhood (1.12; 1.04,1.20), slow speed of traffic (1.19; 1.03,1.35) and few drivers exceeding the speed limits (1.09; 1.03,1.15) were associated with greater odds of reporting at least 10 min/week of transport-related PA. Perceptions of higher levels of land use mix-diversity, better aesthetics and greater safety from crime, the presence of crosswalks and pedestrian signals, and greater proximity of shopping centers were associated with more min/week of transport-related PA. Perceptions of higher land use mix-diversity (1.12; 1.05,1.20), higher land use mix-access (1.27; 1.13,1.43), more walking/cycling facilities (1.18; 1.09,1.28), and better aesthetics (1.10; 1.02,1.18) were associated with greater odds of engaging in at least 10 min/week of leisure-time PA versus none. Perceptions of higher land use mix-diversity were associated with more min/week of leisure PA. CONCLUSIONS: Different perceived neighborhood built environment characteristics were associated with domain-specific PA among adults from Latin America countries. Interventions designed to modify perceptions of the neighbourhood built environment might influence initiation or maintenance of domain-specific PA. TRIAL REGISTRATION: ClinicalTrials. Gov NCT02226627 . Retrospectively registered on August 27, 2014.

Association of the Built Environment With Childhood Psychosocial Stress.

Importance: Emerging research suggests that factors associated with the built environment, including artificial light, air pollution, and noise, may adversely affect children's mental health, while living near green space may reduce stress. Little is known about the combined roles of these factors on children's stress. Objective: To investigate associations between components of the built environment with personal and home characteristics in a large cohort of children who were assessed for perceived stress. Design, Setting, and Participants: In this cohort study, a total of 2290 Southern California Children's Health Study participants residing in 8 densely populated urban communities responded to detailed questionnaires. Exposures of artificial light at night (ALAN) derived from satellite observations, near-roadway air pollution (NRP) determined from a dispersion model, noise estimated from the US Traffic Noise Model, and green space from satellite observations of the enhanced vegetation index were linked to each participant's geocoded residence. Main Outcomes and Measures: Children's stress was assessed at ages 13 to 14 years and 15 to 16 years using the 4-item Perceived Stress Scale (PSS-4), scaled from 0 to 16, with higher scores indicating greater perceived stress. Measurements were conducted in 2010 and 2012, and data were analyzed from February 6 to August 24, 2019. Multivariate mixed-effects models were used to examine multiple exposures; modification and mediation analyses were also conducted. Results: Among the 2290 children in this study, 1149 were girls (50%); mean (SD) age was 13.5 (0.6) years. Girls had significantly higher perceived stress measured by PSS-4 (mean [SD] score, 5.7 [3.4]) than boys (4.9 [3.2]). With increasing age (from 13.5 [0.6] to 15.3 [0.6] years), the mean PSS-4 score rose from 5.6 (3.3) to 6.0 (3.4) in girls but decreased for boys from 5.0 (3.2) to 4.7 (3.1). Multivariate mixed-effects models examining multiple exposures indicated that exposure to secondhand smoke in the home was associated with a 0.85 (95% CI, 0.46-1.24) increase in the PSS-4 score. Of the factors related to the physical environment, an interquartile range (IQR) increase in ALAN was associated with a 0.57 (95% CI, 0.05-1.09) unit increase in the PSS-4 score together with a 0.16 score increase per IQR increase of near-roadway air pollution (95% CI, 0.02-0.30) and a -0.24 score decrease per IQR increase of the enhanced vegetation index (95% CI, -0.45 to -0.04). Income modified the ALAN effect size estimate; participants in households earning less than $48 000 per year had significantly greater stress per IQR increase in ALAN. Sleep duration partially mediated the associations between stress and both enhanced vegetation index (17%) and ALAN (18%). Conclusions and Relevance: In this cohort study, children's exposure to smoke at home in addition to residential exposure to ALAN and near-roadway air pollution were associated with increased perceived stress among young adolescent children. These associations appeared to be partially mitigated by more residential green space. The findings may support the promotion of increased residential green spaces to reduce pollution associated with the built environment, with possible mental health benefits for children.

Integrated modelling of built environment and functional requirements: Implications for resilience.

The built environment is a core part of most healthcare systems, involving a number of requirements such as those related to space and patients' well-being. However, these are usually addressed separately from other functional requirements, resulting in designs that do not support resilient performance. This study proposes a framework for the integrated modelling of built environment and other functional requirements, relying on two approaches: Functional Resonance Analysis Method (FRAM), and Building Information Modelling (BIM). Requirements are defined as equivalent to the precondition aspect of FRAM functions. BIM allows the creation of a database of requirements and functions, linked to an object-oriented model of the built environment. The proposed framework was devised and tested in an intensive care unit. Findings shed light on the necessary resilience to cope with the gap between built environment-as-imagined in design and built environment-as-done due to performance adjustments. This type of resilience may have a long-lasting nature, as many built environment attributes cannot be easily changed.

Combined effects of noise and air temperature on human neurophysiological responses in a simulated indoor environment.

The aim of the present study was to evaluate the combined effects of noise and air temperature on the human body neurophysiological responses. This study was conducted on 35 male students, who were exposed to four different air temperatures (18 °C, 22 °C, 26 °C, and 30 °C) and two noise levels (55 dBA and 75 dBA) in eight sessions in a simulated indoor environment. The mean values of accuracy and time of response to stimuli in N-back test as well as neurophysiological responses were measured. In the studied experiment configurations, with increasing air temperature and noise, the working memory and neurophysiological responses were disturbed. The results indicated the significant effect of noise on working memory, as compared with that of air temperature. The effects of air temperature on heart rate, respiratory rate as well as theta and alpha bands were more significant than the impact of noise. The combined effects of noise and air temperature were more significant than the influence of each of them alone. In the presence of high noise levels, the increase in air temperature did not worsen the response accuracy. However, in the presence of high noise level, the rise in air temperature aggravated the mean value of neurophysiological responses. Overall, noise has a greater effect on working memory, while the air temperature can disturb neurophysiological responses in a more profound way.

The role of architectural design for rheumatic patients' wellbeing: the point of view of Environmental Psychology.

Rheumatic diseases (RD) are among the most frequent disorders in the population and the major causes of chronic pain and disability. The resulting consequences are catastrophic, leading to a significant socio-economic burden, which includes significant reductions in quality of life (QoL) and limitations in regular work and daily activities of patients. In spite of this, rheumatic diseases are often misunderstood or diagnosed late, probably due to their characteristics of silent diseases, sometimes unrecognizable to unaffected or unskilled people. Actually, it is surprising that, despite their consequences on QoL and on individual impact, rheumatic diseases are underestimated by the public opinion, which is probably more attracted by other major diseases causing death. This silent perception can even be seen in some among the most recent psycho-social approaches to population needs in the fields of Health Psychology and Environmental Psychology. The latter, also known as Architectural Psychology, is a branch of Psychology that analyses the effects of the built environment on humans, including those affected by diseases. Paradoxically, in many cases, some components of the environments created to protect individuals and/or the population may represent barriers and subsequently causes of disability and suffering in patients with rheumatic diseases. In order to increase awareness about this particular aspect of social life, HEMOVE Onlus, a non-profit association, has promoted the creation of a multidisciplinary Task Group, which included mainly rheumatologists, psychologists and architects, with the aim of applying also for the benefit of rheumatic patients the most modern technical skills available in the context of Environmental Psychology, including in particular design and information technology.

Environmental information for people with visual impairment in Mexico - or what they need and how they use it.

From an ergonomics perspective, the environmental characteristics should facilitate user activities. Matching user capabilities to demands of the environment is essential. However, about some users such as those with visual impairments, there is little information available for use in designing products and spaces. There is also a gap in information regarding the commutes and needs of the visually impaired, making it even more difficult to establish how environments should be designed to include this population.This study aimed to identify the information needs of people with visual impairment in terms of: 1) Daily life activities, 2) Wayfinding in the complex built environments, 3) Use of the signals provided by the environment 4) Characteristics of the environment which reduce the usability of a space and may put the user in danger, and 5) Safety perception. Data were obtained through a semi-structured interview to which eighteen adults responded. All had either complete blindness or severe visual impairment. For orientation, the most common references were texture or changes in ground level/surface, along with such ambient elements as noise or smells. Information presented in Braille was reported as little used, due to difficulty in finding such information. Regarding safety, participants reported feeling unsafe; most mentioned crossing the street as a major risk. Using auditory, tactile or even olfactory signals may provide important information while commuting: thus, designing signals which consider and highlight these senses is paramount. Assessing features and location of existing tactile signals is also required, to identify opportunities for improving the safety and independence of people with visual impairment.

Using engagement in sustainable construction to improve mental health and social connection in disadvantaged and hard to reach groups: a new green care approach.

Background: The positive impact of the outdoors on physical and mental health is increasingly being evidenced. However, the impact on vulnerable and disadvantaged individuals engaging in group based sustainable building construction has not been examined.Aim: To provide the first pragmatic examination of the impact of engaging in a brief (8 days over 8 weeks) outdoor sustainable construction project on the mental health and social connectedness of hard to reach and disadvantaged groups.Methods: In study 1, 93 young people not in education, employment or training took part whilst study 2 comprised 55 adults who were asylum seekers, long-term unemployed or men with longstanding depression. Self-report data were collected at baseline and towards the end of the programme.Results: Those with poor mental health and social connection at baseline showed statistically and clinically significant improvements in depression, anxiety, resilience and social connection by the end of the brief intervention.Conclusion: Engagement in a group based sustainable construction project can provide significant mental health and social benefits to a range of vulnerable and hard to reach groups with difficulties in these areas. Building on these findings could be important for health and social care policy for marginalised groups.

Direct and Indirect Relationships Between the Built Environment and Individual-Level Perceptions of Physical Activity: A Systematic Review.

BACKGROUND: Socioecological models highlight the potential direct and indirect effects of multiple levels of influence in explaining physical activity (PA). Social cognitive theories, however, position individual cognitions as the mediator of external factors such as the built environment when explaining PA. PURPOSE: To appraise the evidence for direct and indirect associations between the built environment and social cognition to predict PA. METHODS: Literature searches were concluded in February 2019 using five common databases. Eligible studies were in the English language that included any direct and indirect tests of individual perceptions and the built environment with PA. RESULTS: The initial search yielded 18,521 hits, which was reduced to 46 independent studies of primarily medium quality after screening for eligibility criteria. Findings were grouped by type of PA then grouped by the type of individual and built environment constructs within the model, and subdivided by adult and youth samples. There was evidence that self-efficacy/perceived control accounted for the covariance between environmental accessibility/convenience and total PA, while habit accounted for the covariance in this relationship for transport PA, particularly in adult samples. There was no evidence that the built environment had a direct association with PA after controlling for individual-level factors. CONCLUSIONS: The results provide initial support for the mediation tenet in social cognition models for the relationship between individual, built environment, and PA. In practice, these findings highlight the need for coordinated interventions of individual and environmental change.

Perceived Importance of Physical Activity and Walkable Neighborhoods Among US Adults, 2017.

The importance of physical activity and community-level promotion strategies are well established, but little is known about adult perception of the importance of physical activity. In a nationwide sample of US adults, we examined self-reported importance of regular physical activity and the importance of living in walkable neighborhoods. About 55% of adults strongly agreed that regular physical activity is important, 40% strongly agreed that living in a walkable neighborhood is important, and 31% strongly agreed that both are important. Separately for each measure, estimates were lower among adults with lower education levels and who did not meet the aerobic physical activity guideline. Opportunities exist to improve the perception of the importance of physical activity and the importance of walkable neighborhoods.

Comfortable indoor lighting conditions for LEDlights evaluated from psychological and physiological responses.

Comfortable light emitting diode (LED) lighting conditions were examined for psychological and physiological responses. Eight male and eight female subjects participated in a series of experiments. They were exposed to light emitted from LED lights of 3000 K in the ranges of 150-400 lux and 1500-5000 lux; 4000 K in the ranges of 140-640 lux and 2000-5000 lux; and 5000 K in the ranges of 70-270 lux and 2500-7000 lux. Illuminance at a given correlated color temperature was first maintained at the lowest value in the designated range and then increased in a stepwise manner. On reaching the highest value in the range, it was then decreased to the lowest value in a stepwise manner. The subjects were required to indicate their perception of brightness, glare, and comfort at the controlled illuminance levels. Electrocardiogram and electroencephalogram data were monitored continuously throughout exposure. The results showed that the boundary illuminances estimated from psychological and physiological responses did not significantly differ between male and female subjects, but differed markedly from those of fluorescent lights tested in a previous study. The high boundaries of the LED lights were higher than those of the fluorescent lights. The low boundaries of the LED lights at 3000 K and 4000 K were higher than those of the fluorescent lights, but the boundaries at 5000 K were lower than those of the fluorescent lights. These differences may be due to differences in the spectral distribution and luminance for a given illuminance between LED and fluorescent lights.

Open plan office space? If you're going to do it, do it right: A fourteen-month longitudinal case study.

There are compelling findings that open-plan office environments are associated with declines in employee wellbeing. In spite of this, the move towards shared office environments continues; yet there is a lack of research describing open-plan offices that have positive outcomes for workers. We describe a "best practice" open-plan fit-out of a law firm and provide data from occupants relating to their performance, well-being, and collegial relationships. Six months after moving to an open-plan office, staff were anonymously surveyed, and 24 were interviewed. Fourteen months later, occupants responded to a follow-up survey. Positive outcomes relating to aesthetics, collegiality, and communication were achieved through good technical design and thoughtful ergonomic assessment of the needs of employees and the requirements of their tasks. A gender difference emerged whereby female, but not male, workers in this environment reported feeling observed. This has implications for the relatively different impact these environments may have on workers. Thus, by following ergonomic principles to create open-plan offices that are 'safe by design' organizations can ameliorate many of the negative consequences associated with these environments.

Is greenery associated with mental health among residents of aged care facilities? A systematic search and narrative review.

Objectives: Older adults living in residential aged care facilities (RACFs) may be vulnerable to mental health issues. Evidence suggests greenery is beneficial for adults' mental health in community settings. This review aims to summarise evidence of associations between greenery in RACFs and residents' mental health.Method: Six databases were searched with three sets of terms related to: (1) exposure (e.g. garden, green); (2) outcome (e.g. mental health, well-being); and (3) setting (e.g. aged care, nursing home). The inclusion criteria were peer-reviewed journal articles published in English up to 2017, reporting quantitative/qualitative associations between greenery and mental health in RACFs.Results: Of the nine articles identified, seven reported positive associations between greenery (in particular, garden use) at RACFs and some aspect of residents' mental well-being (e.g. quality of life); however, four out of seven studies used observations and perceptions of staff and relatives. One study examined depression and reported reduction in depression following garden use, while one examined physiological indicators of stress (blood pressure, heart rate) and found no association with garden use. Seven studies examined garden use and four examined the presence of greenery (two examined both exposures).Conclusion: Exposure to greenery and use of greenspace in RACFs show promise for promoting mental health. However, the findings relied mainly on non-validated measures of mental health. More robust evidence based on valid and reliable mental health measures is needed. Future studies also need to examine the effect of visual exposure to greenery and the effect of greenery on stress reduction.

Development and assessment of a home environment checklist to evaluate mismatch between patients' ability and home environment.

BACKGROUND: Modification of the home environment, together with rehabilitative interventions, is important for maximizing the level of functioning after an individual with disability undergoes rehabilitation in the hospital. OBJECTIVES: We developed a simple screening scale - the home environment checklist (HEC) - to identify any mismatch between an individual's abilities and their home environment to help clinicians monitor the appropriateness of the home environment to which individuals with disability will be discharged. We also examined the psychometric properties of the HEC. METHODS: The HEC was developed by a multidisciplinary panel of rehabilitation experts using information routinely collected in rehabilitation clinics before discharge. The reliability of the checklist was assessed in 60 individuals undergoing rehabilitation. The inter-rater agreement and internal consistency of the scale were assessed by weighted kappa statistics and Cronbach's alpha, respectively. Rasch analysis was performed with 244 rehabilitation individuals to evaluate the internal construct validity, and the known-groups validity was confirmed by a comparison of the daily activity levels of 30 individuals with disabilities under rehabilitation to the HEC score. RESULTS: The HEC was developed as a simple, 10-item checklist. The weighted kappa statistics ranged from 0.73 to 0.93, indicating excellent inter-rater reliability. Cronbach's alpha was 0.92, indicating high internal consistency. Rasch analysis with a testlet approach on 3 subscales demonstrated a good fit with the Rasch model (χ2=13.2, P=0.153), and the demonstrated unidimensionality and absence of differential item functioning supported the internal construct validity of the HEC. HEC scores were significantly different (P<.01) among individuals with disability and 3 levels of restrictions in their activities (no limitation, home-bound, and bed-bound), which demonstrates the known-groups validity of the HEC. CONCLUSIONS: The HEC has good reliability and validity, which supports its utility in rehabilitation clinics.