Select Page

The Development of a Community Health Inclusion Index (CHII)


The instruments currently being used to measure physical activity and healthy eating resources at the community level have not been designed to capture the needs of people with disabilities. As a result, the strategies being formulated to build healthy communities do not represent the needs of people with disabilities.

An instrument that measures a community’s healthy living resources must be a comprehensive tool that is convenient, portable and accessible to any community, large or small, and represent the needs of all members of that community.  Our project to develop the Community Health Inclusion Index (CHII) will provide communities with the ability to measure how well they support healthy, active living for all members of the community, including people with disabilities.  The CHII will be developed in three phases: Phase I) Instrument Development will involve the development of the CHII’s domains and structure, refinement of items and draft of the CHII; Phase 2) Instrument Validation will involve cognitive testing of the instrument’s comprehension and clarity and large scale field testing; and Phase 3) Data Analysis will involve psychometric analysis and validity and reliability testing.

The Community Health Inclusion Index will be developed with the highest level of statistical accuracy and validity. The project incorporates Rasch measurement to achieve precision in measurement; an expert panel composed of key researchers and practitioners who have expertise in community health, aging, disability and minority populations to ensure appropriate item development and rankings; a comprehensive set of national focus groups to collect items and difficulty rankings of healthy community venues;  extensive field testing validation with partners from CDC’s Disability and Health State Grantees in geographically diverse communities across the U.S. to ensure instrument generalizability; and detailed psychometric analysis that will result in an instrument that can be used to measure healthy, active living resources at either the community level, or for the targeted settings that define a community including schools, recreation facilities, health care sites, workplaces and food environments (grocery and restaurants).

The outcome of this project is a Community Health Inclusion Index for determining aspects of the community that are critical for improving healthy, active living for people with disabilities.  The impacts of the CHII will be seen in the short term by creating awareness and knowledge that people with disabilities should be part of all future community health transformation initiatives across the U.S.; in the intermediate term through increased access to physical activity and healthy eating resources; and in the long-term through a reduction in the risk of obesity and other chronic health conditions.

The Need for a Universal Instrument

There are two dichotomous sets of instruments that are currently being used to promote community health (Figure 1). One set is typically used by professionals in disability, rehabilitation and public health because items relate directly to disability-related issues (e.g., AIMFREE, Q-PAT, FABS, CHEC, CHIEF), while the other set of instruments focuses primarily on non-disabled populations including aging, minorities and the general public (e.g., HAN-EAT, CHANGE, CHLI).

While each set of instruments has their place in addressing obesogenic environments, the lack of a universal assessment tool that recognizes the needs of all sub-populations living in a community often results in two different sets of community health recommendations at best, or at worst, in a lack of attention to the needs of people with disabilities. This creates missed opportunities for disability professionals to work with health professionals in designing communities that are universally accessible to all its citizens.  Our approach in meeting this gap is to develop a universal assessment tool that contains items that are appropriate for people with and without disabilities and is referred to as the Community Health Inclusion Index or CHII.


Send to Yochai Eisenberg: