Background:
Despite the fact that rural children are at elevated risk of obesity, active living research and interventions have been limited primarily to urban and suburban settings. As a result, it is unclear if these interventions are appropriate to rural environments or if a different approach is needed. To partly address this gap, we devised a conceptual framework that models the interaction between the individual and the environment as it enhances or hinders active living in rural communities. Based on this rural model, we have developed and refined a rural-specific environmental audit tool and corresponding codebook to help assess the activity-friendliness of rural communities.
Objectives:
This rural audit tool is intended to be used by community members, policymakers, program staff, planners and researchers to assess the degree to which the physical, program, and policy environments of a rural community support active living. In prior work we found it necessary to adapt and simplify urban instruments for small rural communities where many elements of these instruments are not relevant, but where other features of the environment are applicable. Combining findings from three previously funded rural ALR grantees (i.e. University of Southern Maine, Tufts University, and University of Mississippi/University of Alabama) we developed, tested, and refined a rural-specific audit instrument.
Our rural-specific instrument will provide a necessary foundation for future active living studies and interventions as they create an evidence base for increasing physical activity in rural areas. The success of any interventions would be increased by correlational studies to determine what physical features, design features, programs and policies in rural environments are correlated with increased levels of physical activity. This instrument contributes to these future studies by providing a tool with which to capture salient features of the rural environment that can be tested by correlation analyses.
Methods:
In order to construct a comprehensive rural audit tool, we assessed existing active living audit tools previously developed for urban areas, including the Irvine Minnesota and SPACES audit tools, to determine their usefulness and significance in rural communities. Using these tools as guides, we used the qualitative data we collected when developing our rural conceptual model to adapt and supplement urban-based audit questions in order to create a tool that captured the environmental elements we believe to be most influential in supporting or thwarting active living in rural areas.
The audit tool was pilot tested in 3 rural Maine communities and necessary adjustments were made before taking it to the field. In collaboration with the other two rural ALR grantees, the tool was then administered in multiple rural communities across the United States. Inter-rater reliability was assessed.
Results:
Because of some of the unique qualities that are characteristic of rural communities, we found that urban-based active living audit instruments are not appropriate for use in rural areas. The physical environment varies quite significantly across different rural towns, some of which may have a defined, grid-like town center and others that have little or no discernable town center. Topographical and natural barriers and lack of sidewalks, crosswalks and other features that often exist in more urban centers make many rural communities not easily walkable.
Consequently, we found a rural audit tool needs to include questions relating to rural town settlement patterns, town-wide features and amenities, and programs and policies, in addition to physical environmental features that may support or deter rural active living. Additionally, we found that defining segments for the rural audit is more difficult and complicated in rural areas when compared to urban centers that can be easily segmented using city blocks or previously defined neighborhoods. Our audit tool and codebook therefore includes detailed instructions on various ways to define rural segments. Our rural audit tool includes three separate assessments to be used in conjunction with each other: the Town-Wide Assessment, the Segment Assessment, and the Program and Policy Assessment. These assessments offer the opportunity to collect information about factors related to rural active living in a simple and meaningful way.
Conclusions:
Previous ALR rural grantees have found that the existing urban-based active living environmental audits tools are not appropriate for use in rural areas. By developing, testing, and refining a rural audit tool based on extensive qualitative data about barriers and supports to rural active living, we were able to devise a comprehensive rural audit tool that addresses many of the unique factors important to active living in rural communities. This tool, once further tested for appropriateness and reliability, will offer rural researchers, policy makers, program planners and community members a resource to assess rural environments for activity-friendliness and help to eventually design evidence-based environmental interventions, programs and policies to help support rural communities in their efforts to be more active and healthy.
Support:
The Robert Wood Johnson Foundation Active Living Research program
