Virtual Assessment of Physical Activity-Related Built Environment in Soweto, South Africa: What Is the Role of Contextual Familiarity?

Understanding how urban environments shape physical activity is critical in rapidly urbanizing countries such as South Africa. We assessed the reliability of virtual audits for characterizing urban features related to physical activity in Soweto, South Africa. We used the Microscale Audit of Pedestrian Streetscapes Global tool to characterize pedestrian-related features from Google Street View images in four neighborhoods of Soweto. Neighborhoods were selected to represent different levels of deprivation. Inter-rater reliability was analyzed according to the rater's familiarity with the local area. The results show a higher inter-rater reliability was observed among auditors with greater contextual familiarity. Many measurements however generated inconclusive results due to either low variability in the raters' responses or the absence of the features in the streets. It is evident from our findings that virtual audits are efficient tools that can be used to assess the built environment. However, to ensure meaningful use of these tools in diverse settings, we recommend that auditors comprise of people with contextual familiarity.

A Mixed-Methods Participatory Intervention Design Process to Develop Intervention Options in Immediate Food and Built Environments to Support Healthy Eating and Active Living among Children and Adolescents in Cameroon and South Africa.

Rates of obesity and related non-communicable diseases are on the rise in sub-Saharan Africa, associated with sub-optimal diet and physical inactivity. Implementing evidence-based interventions targeting determinants of unhealthy eating and physical inactivity in children and adolescents' immediate environments is critical to the fight against obesity and related non-communicable diseases. Setting priorities requires a wide range of stakeholders, methods, and context-specific data. This paper reports on a novel participatory study design to identify and address contextual drivers of unhealthy eating and physical inactivity of children and adolescents in school and in their home neighborhood food and built environments. We developed a three-phase mixed-method study in Cameroon (Yaoundé) and South Africa (Johannesburg and Cape Town) from 2020-2021. Phase one focused on identifying contextual drivers of unhealthy eating and physical inactivity in children and adolescents in each setting using secondary analysis of qualitative data. Phase two matched identified drivers to evidence-based interventions. In phase three, we worked with stakeholders using the Delphi technique to prioritize interventions based on perceived importance and feasibility. This study design provides a rigorous method to identify and prioritize interventions that are tailored to local contexts, incorporating expertise of diverse local stakeholders.