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Reliability of perceived neighbourhood conditions and the effects of measurement error on self-rated health across urban and rural neighbourhoods
  1. Sandi L Pruitt1,
  2. Donna B Jeffe1,2,
  3. Yan Yan3,
  4. Mario Schootman1,2
  1. 1Washington University School of Medicine, Department of Medicine, Division of Health Behavior Research, St Louis, Missouri, USA
  2. 2Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, Missouri, USA
  3. 3Washington University School of Medicine, Departments of Surgery and Biostatistics, St Louis, Missouri, USA
  1. Correspondence to Dr Sandi L Pruitt, Washington University School of Medicine, Department of Medicine, Division of Health Behavior Research, Box 8504, 4444 Forest Park Avenue, Suite 6700, St Louis, MO 63108, USA; spruitt{at}


Background Limited psychometric research has examined the reliability of self-reported measures of neighbourhood conditions, the effect of measurement error on associations between neighbourhood conditions and health, and potential differences in the reliabilities between neighbourhood strata (urban vs rural and low vs high poverty). We assessed overall and stratified reliability of self-reported perceived neighbourhood conditions using five scales (social and physical disorder, social control, social cohesion, fear) and four single items (multidimensional neighbouring). We also assessed measurement error-corrected associations of these conditions with self-rated health.

Methods Using random-digit dialling, 367 women without breast cancer (matched controls from a larger study) were interviewed twice, 2–3 weeks apart. Test–retest (intraclass correlation coefficients (ICC)/weighted κ) and internal consistency reliability (Cronbach's α) were assessed. Differences in reliability across neighbourhood strata were tested using bootstrap methods. Regression calibration corrected estimates for measurement error.

Results All measures demonstrated satisfactory internal consistency (α≥0.70) and either moderate (ICC/κ=0.41–0.60) or substantial (ICC/κ=0.61–0.80) test–retest reliability in the full sample. Internal consistency did not differ by neighbourhood strata. Test–retest reliability was significantly lower among rural (vs urban) residents for two scales (social control, physical disorder) and two multidimensional neighbouring items; test–retest reliability was higher for physical disorder and lower for one multidimensional neighbouring item among the high (vs low) poverty strata. After measurement error correction, the magnitude of associations between neighbourhood conditions and self-rated health were larger, particularly in the rural population.

Conclusion Research is needed to develop and test reliable measures of perceived neighbourhood conditions relevant to the health of rural populations.

  • Measurement
  • neighbourhood
  • observer agreement
  • psychometrics
  • public health epidemiology
  • reliability and validity
  • rural population
  • urbanisation

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  • Funding This research was supported in part by grants from the National Cancer Institute (CA112159, CA91842), and preparation of the manuscript was supported in part by the first author’s Alvin J Siteman Cancer Center Prevention and Control Program postdoctoral fellowship and her career development award from the Institute of Clinical and Translational Sciences at Washington University in St Louis, funded by the National Institutes of Health/National Center for Research Resources (KL2 RR024994). Its contents are solely the responsibility of the authors and do not necessarily represent the views of the funding agencies.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Washington University School of Medicine and the University of Missouri - Columbia institutional review boards.

  • Provenance and peer review Not commissioned; externally peer reviewed.