Development and validation of a tool to assess the rural neighborhood environment for obesity in Korean adults

Objectives: This study aimed to develop and validate a tool that assesses the perceived neighborhood environments influencing obesity development among rural adults in Korea. Design and Samples: Qualitative and quantitative methods were used. Twenty-one adults participated in focus group interviews. Subsequently, two independent surveys were conducted with rural adults aged 19–65. Measurements: Literature review and focus group interviews were used to generate initial items. An expert's panel evaluation established content validity for these items and pilot testing of the draft tool was performed. Explanatory (n = 328) and confirmatory factor analyses (n = 1,070) were used to establish construct validity, and internal consistency and test–retest reliability were calculated (n = 88). Results: The new tool consisting of 37 items was developed and validated. Confirmatory factor analysis revealed an eight-subscale structure (χ² = 3,738.1, GFI = 0.831, SRMR = 0.060, RMSEA = 0.070). The tool showed moderate test–retest reliability (ICC = 0.519–0.775) and good internal consistency except for Social Influence on Healthy Eating (Cronbach's α = 0.612). Conclusions: The Rural Neighborhood Environment Assessment for Obesity tool might be a valid and reliable instrument for public health practitioners to assess complex social and physical environmental factors related to obesity.