Development of Measures of Perceived Neighborhood Environmental Attributes Influencing, and Perceived Barriers to Engagement in, Healthy Behaviors for Older Chinese Immigrants to Australia.

Environmental correlates, barriers, and facilitators of physical activity, healthy eating, and socializing are understudied in older immigrants to developed countries. This study developed/adapted and validated measures of perceived barriers and neighborhood environmental characteristics related to these health-enhancing behaviors appropriate for older Chinese immigrants to Australia and similar Western countries. Older Chinese immigrants living in Melbourne (Australia) were recruited from neighborhoods varying in walkability and percentage of Chinese residents. Versions of the Neighborhood Environment for Healthy Aging-Chinese Immigrants to Australia (NEHA-CIA) questionnaire (20 subscales) and the Perceived Barriers to Health-Enhancing Behaviors questionnaire (four subscales) were developed from extant validated scales and information collected in formative qualitative research. Thirty-one participants took part in cognitive interviews aimed to pilot-test and refine the questionnaires. The modified questionnaires were administered to 52 participants twice, two weeks apart. Test-retest reliability (intraclass correlation coefficients), internal consistency (Cronbach's α), and construct validity (associations with theoretically-relevant constructs) were examined. Most items and subscales of both questionnaires had good test-retest reliability and internal consistency, while the NEHA-CIA also showed good construct validity. Future studies need to further examine the construct validity of the questionnaire of perceived barriers and determine the factorial validity of both measures on large representative samples.

Built and social environmental factors influencing healthy behaviours in older Chinese immigrants to Australia: a qualitative study.

BACKGROUND: Neighbourhood environments influence older adults' health and health-enhancing behaviours, such as physical activity, eating a healthy diet and socialising. However, little is known about the effects of the neighbourhood environment on the health of older immigrants, the number of which is rapidly increasing in developed countries. Using Nominal Group Technique (NGT) sessions, this study of older Chinese immigrants to urban Melbourne, Australia, examined built and social environmental facilitators of and barriers to regular engagement in physical activity, eating a healthy diet and regular contact with other people. METHODS: Participants were recruited from four types of neighbourhoods stratified by walkability and proportion of Chinese dwellers. Twelve NGTs, four specific to each of physical activity, healthy diet and social contacts were conducted in Mandarin or Cantonese (91 participants). NGT responses from groups addressing the same questions were aggregated, similar items were combined, and scores combined across groups. Inductive thematic analysis was used to categorise answers into higher-order themes of factors associated with each behaviour. RESULTS: For physical activity, 29 facilitators and 28 barriers were generated with the highest ranked facilitator and barrier being "proximity to destinations" and "poor/inadequate public transport", respectively. For healthy diet, 25 facilitators and 25 barriers were generated, the highest ranked facilitator and barrier were "high food safety standards/regulations" and "lack of family/household members' social support for a healthy diet". The social contacts NGTs generated 23 facilitators and 22 barriers, with the highest ranked facilitator and barrier being "proximity to destinations and activities" and "poor public transport", respectively. DISCUSSION: Independent living arrangements and the accessibility of destinations of daily living (e.g., bilingual health services, libraries, places of worship and grocery stores / supermarkets), recreational facilities, affordable public transport, and community centres and activities for Chinese people are key elements for promoting regular engagement in physical activity, healthy eating and socialising in older Chinese immigrants. Governments should plan for the provision of this basic infrastructure of community facilities for older immigrants.