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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Public Health 1/2015

Development of a community health inclusion index: an evaluation tool for improving inclusion of people with disabilities in community health initiatives

BMC Public Health > Ausgabe 1/2015
Yochai Eisenberg, James H. Rimmer, Tapan Mehta, Michael H. Fox
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12889-015-2381-2) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

YE was the PI on the study and managed all the phases of the research. YE and JHR conceptualized the methodology, obtained funding and were the primary contributors to this manuscript. TM provided the statistical expertise for the study - he was not involved in developing the CHII but undertook all aspects of analysis and helped prepare the manuscript. MHF was the science officer at the CDC that funded this study and provided consultation on the project. MHF contributed to the preparation and editing of the manuscript. All authors read and approved the final manuscript.

Authors’ information

YE (MUPP) is a project manager at the Center on Health Promotion Research for Persons with Disabilities at the University of Illinois at Chicago. His research focuses on community accessibility, the built environment, Geographic Information Systems (GIS) and health promotion for people with disabilities. JHR (PhD) is Director of the UAB/Lakeshore Foundation Research Collaborative, and Lakeshore Foundation Endowed Chair in Health Promotion and Rehabilitation Sciences. He has been developing and directing physical activity and health promotion programs for people with disabilities for over 30 years. JHR is currently on the Scientific Committee of the President’s Council on Fitness, Sports and Nutrition. TM (PhD) is an Assistant Professor in the Department of Physical Therapy at the University of Alabama at Birmingham. He directs and leads the statistical analysis and design of the UAB/Lakeshore Research collaborative in the area of disability and rehabilitation sciences. MHF (ScD) is the Associate Director for Science in the Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC) and Professor at University of Kansas Medical Center.



Community health initiatives often do not provide enough supports for people with disabilities to fully participate in healthy, active living opportunities. The purpose of this study was to design an instrument that focused on integrating disability-related items into a multi-level survey tool that assessed healthy, active living initiatives.


The development and testing of the Community Health Inclusion Index (CHII) involved four components: (a) literature review of studies that examined barriers and facilitators to healthy, active living; (b) focus groups with persons with disabilities and professionals living in geographically diverse settings; (c) expert panel to establish a final set of critical items; and (d) field testing the CHII in 164 sites across 15 communities in 5 states to assess the instrument’s reliability.


Results from initial analysis of these data indicated that the CHII has good reliability. Depending on the subscale, Cronbach’s alpha ranged from 0.700 to 0.965. The CHII’s inter-rater agreement showed that 14 of the 15 venues for physical activity or healthy eating throughout a community had strong agreement (0.81 – 1.00), while one venue had substantial agreement (0.61 – 0.80).


The CHII is the first instrument to operationalize community health inclusion into a comprehensive assessment tool that can be used by public health professionals and community coalitions to examine the critical supports needed for improving healthy, active living among people with disabilities.
Additional file 1: Literature Review Results.pdf : Includes 1) a flow chart showing the number of manuscripts found and kept as well as sample barriers and facilitators used from this source and (2) a list of instruments selected to be used for building CHII item bank. (PPTX 35 kb)
Additional file 2: Focus Group Results.pdf: Shows 1) the demographics of the adults and youth with disabilities as well as the professionals who participated in the focus groups and 2) a list of sample codes developed from focus group transcripts organized by domain of the CHII. (DOCX 21 kb)
Additional file 3: Expert Panel Results.xlsx: A database of the items kept and removed by the Expert Panel as part of the development of the CHII. (XLSX 25 kb)
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