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BMC Public Health| BMC Public Health

Main findings

Participants from 254 different postcodes (21.7% of the island) did not rate other features in the residential environment favorably. They scored the lowest scores for influence, control, and public transport. The Place Standard’s construct validity is supported by a clear dimensionality of the Built, Physical, Social, and Service environment. People who rated their neighbourhoods lower on the social ladder were more likely to rate them less favorably across all items or domains. Subjective neighbourhood social status was more strongly associated with the overall Place Standard score, rather than any one item. This could indicate that participants intuitively take into account many aspects in their relative assessment. According to census-based built (e.g. Mixed-used buildings, apartment blocks, pre-1980 housing, or socio-demographic characteristics (e.g. Single-parent households were more consistent in terms the built environment than the social, physical or service environment.

Standard for Dimensionality of Place

The Place Standard has been used in a variety of settings in at least 14 European nations, most often in the contexts of community engagement and development. Except for a few exceptions, certain aspects of the tools’ metric properties are not included in the published literature. The online citizens perception survey in Skopje (North Macedonia) reported the internal consistency of overall scale (Cronbachs coefficient for internal consistency=0.892), which matches the figure reported here. Our study showed that conceptually related PST items had moderate to high correlations, which indicates good convergence validity. Our study also revealed a clearly identifiable and easily interpretable dimensionality for four sub-scales with high internal consistency. The scales construct validity was supported by the variable reduction achieved (from 14 districts ratings to four theoretical constructs). This may simplify and allow for the scale to be used in research studies.

Comparison of the Place Standard and other quality metric tools for neighbourhoods

There are many neighbourhood tools available in the literature that can be used for surveying residents’ perceptions about the quality and/or problems with negatively phased items such as the Neighbourhood Problems Scale. [34]. Some of these tools were purposefully created through a psychometric or ecometric validation process such as the Neighbourhood Score by the Observatory for Urban Health in Belo Horizonte Brazil [10]In other cases, however, only a few items that relate to particular features of interest are chosen as they are most appropriate for the purpose of the study. [8, 9, 34, 35]. One of the most attractive features of the Place Standard is its explicit reference to equity. Additional questions prompt the raters to consider the inclusiveness and quality of Place (e.g. No matter their age, mobility or disability, or ethnic group, religion, belief, or sexual orientation.

Other than being feature-specific, findings of neighbouring studies are setting-specific and therefore do not allow for direct comparisons. However, it is possible to make some comparisons in terms of domains that are often assessed. Friche and colleagues. A questionnaire was created with ten domains, and 70 items (out 84 items) in the study by Friche et al. [10]. Although there is no direct match between the 14 dimensions of the Place Standard and the ten multiitem domains in the Neighbourhood Scale (numbered below), a thorough examination reveals significant overlap, particularly if prompt questions are included to aid in the rating of core item of Place Standard Tool (PST). For example, 1. Safety (2 items), and 2. Violence (6 items) & 3. Social disorder (6 items) and 6. Walking environment (7 items) is based on PSTs moving about, 5. Social cohesion (6 Items) focuses on social contact, but also partly on identity/belonging, 6. Neighbourhood involvement (11 items), jointly on identity and belonging, influence, and sense of control. Aesthetic and 8. PSTs Care and Maintenance is a joint effort to address physical disorder. Quality of services (8 items) & 10. These problems are not all inclusive. They include PSTs public transport, facilities, amenities, work, traffic and parking, streets, spaces, play & recreation, and work. PSTs natural space, housing and community don’t seem to be represented well in the Neighbourhood Scope.

It is important that these domains can be interconnected. For example, the walkability of a neighbourhood would be affected by both safety and aesthetic quality. quality of pavements). Neighbourhood scale [10]This is reflected as overlap in a number items in sub-scales, while in the case for the Place Standard, complexity is reflected via prompt questions that tap into related aspects (e.g. Do you feel safe using routes all year and at different times of day?Safety is an important aspect of Moving around. Even though physical activity is the only focus, qualitative studies have shown that there are many influences in the built, physical, and social environment. [36]. This complexity is often not reflected in measurement scales. Sometimes, constructs may have multiple dimensions of Place, despite their internal consistency. Mujahid et al. (2007) refers to the construct as “neighborhood aesthetic value”. (2007) includes 6 items that are not only about aesthetics but also relate to various dimensions of the Place Standard, such as Care and Maintenance (e.g. item the buildings and homes are well-maintained) and Recreation (e.g. There are many things to do in my neighborhood. [12].

Residents’ perceptions about the residential environment

Previous studies have examined whether citizens’ perceptions about their residential environment reflect objectively measured metrics. This was done using neighbourhood audits. Mixed findings were also found across studies. [9, 11], as well a within studies in terms different neighbourhood environment domains [9]. A systematic review of this issue, which focused only on physical activity outcomes and 85 studies, found low to moderate agreement between objective neighbourhood environment measures and perceived neighbourhood environments measures across 85 studies. It concluded that these are not interchangeable and could represent different constructs. [37]. A recent study that used existing questionnaires to develop a new questionnaire about active mobility found discrepancies. It was based on interviews with citizens and a typology which factors were developed from those interviews. The results showed that even the most common items in walkability questionnaires such as community life and quality of sidewalks were not strongly reflected by people’s perceptions. [38].

Although studies have identified many socio-demographic and environmental factors that could be related to this disagreement, the reported associations did not always match across studies. Both approaches are essential and complementary. The review also concluded that it was important to examine how different environments can influence perceptions and whether these might be different across socio-demographic categories. [37]. Although this aspect was not included in the study, it is one of the aims for the larger CyNOTes project to explore residents perceptions across a stratified sampling of Limassol neighborhoods, selected along the socioeconomic disadvantage continuum. Also, the association of audit scores and perception scores with quality of life. Although it is not clear whether perceptions of place mediate the relationship between neighbourhood environment, health, and quality of life, it is likely that both are involved. [39, 40].

In the SPOTLIGHT project, virtual auditors using Google Street View in 60 European neighborhoods were compared with self-reported responses of approximately 6000 people. [9]. The study examined 10 obesogenic elements in the neighborhood environment. Higher agreement was found in the case where the service environment was concerned (e.g. There were more people who agreed on the presence of food outlets, recreational facilities, and other destinations than there was in the case of features that had a greater degree of subjectivity about the built or physical environment. Conditions of pavements, litter, graffiti, with residents perceiving highly walkable neighbourhoods as less walkable, or vice-versa, according to objective criteria. The authors note this discordance and emphasize the importance of including residents’ perceptions in community assessments beyond objective measures. It is ultimately residents’ perceptions and their determinants, which can include both socio-demographic as well as psychosocial factors. The study found that people with financial problems were more likely than others to rate their neighbourhoods as unfavorably. This is likely to reflect actual disadvantaged neighborhood conditions. It is also supported by lower scores in areas with higher socioeconomic disadvantage, as indicated by census indicators. Previous studies have shown that perceptions of poverty can be affected depending on personal circumstances. Kamphuis et al. (2010) [8]The results showed that 14 neighbourhoods in Eindhoven (Netherlands) had objective (audited), neighbourhood conditions that largely explained the perceptions and perceptions of unsafeness and unattractiveness among lower income groups. However, mental well-being, psychosocial factors, and perceptions of neighbourhood social cohesion also played a role. A qualitative study of 28 adults from five different Brussels neighborhoods revealed a socioecological framework for how citizens perceive their residential environment. [41]. The study revealed complex bi-directional interactions between neighbourhood and mental well-being. These include an inter-play between both physical and social contextual elements of place as well as institutional (e.g. The study highlighted the importance of participatory approaches to cultivating a sense community.

Poortinga et al. Poortinga et al. (2017) found that residents’ attachment to their neighbourhood was predicted by the quality of the neighbourhood environment (audited with the REAT 2.0 tool), even though it was property-level (related peoples personal space such a condition of front yards) and not street-level indicators that were more predictive [11]. This distinction between the public and private realms of place is important. However, it raises questions about attachment as a pre-requisite for taking action. This study found that the Place Standards Identity, and sense of belonging, which are the most important items for attachment, had positive but weak associations with all other PST items with the exception of social contacts. While the social environment construct (these two items), was inversely associated to the subjective assessment about neighbourhoods social status, the observed variability of the scores was not associated with any individual or area-level variables. Attachment and neighbourhood social cohesion are more complex concepts than one item can capture. Hes et al. (2021). Hes et.al. [17].

Citizens participation

Influence and a sense that you have controlThe item that received the lowest rating from participants was this. Although many communities and municipalities across Cyprus have recently re-examined their approaches and started to implement community-led neighbourhood group groups, it is fair that community engagement most often takes the traditional form. This includes a presentation of the local authorities’ plans with limited input from citizens. These sessions are sometimes referred to as open-call public consultations. These public events provide information to citizens interested in the plans and actions of the authorities. There is very little room for negotiation, and there is no consultation with the wider community. Referring to Arnstein’s (1969), ladder of participation [42]These activities, despite appearing participatory, are tokens and are viewed by the community as such. Participation is highly variable and largely dependent upon the issue at hand. It is also subject to vested financial and political interests. Even though concerns and/or ideas may be discussed, or sometimes even negotiated in the face of strong opposition there is no clear feedback channel between authorities and the community. Also, the process is not officially embedded in the decision making process.

Nursey-Bray (2020), gives a detailed explanation of the principles and processes, tools, and skills required for community engagement [43]The International Association for Public Participation (IAPP) describes, which can be best understood as a continuum.www.iap2.orgIt all depends on how much control you have over the decision-making process. This can range from information to the public about the problem and possible solutions to consultation, involvement, collaboration, empowerment and sharing of information at the other end. The PCT’s primary purpose is to be used to promote community engagement and place-making in Cyprus. It offers the opportunity to re-think and test ineffective processes and to restructure them. It is important that we mention that in recent years, there have been many neighbourhood projects established in Cyprus. However, these are dependent on limited and competitive funding options and/or are not always free of political motivations or aspirations. One example is the yiatilemeso.com [Greek: For Limassol]Local architect led the initiative. It offers citizens the opportunity to participate in public consultations through both online discourse platforms and in the contexts of physical events and debates. Another example is the grassroot initiative MY SquareProject, funded by the European Solidarity Corps via the Youth Board of Cyprus. This is a participatory project that brings together the Mesa Yeitonia municipality of Limassol through all stages in re-designing one the main squares. Horgan and Dimitrijevi (2010) reflect on whether any activity is possible while discussing top-down as well as bottom-up strategies. It can be considered tokenistic if it is not compatible with the will and power of government and is unable to affect real decision-making [44]. While tools such as the Place Standard are useful in structuring discussions about place and health within communities, the extent to which this is a voice or token depends on how well the process can be embedded in decision-making processes.

Because of the inherent bias of our study and the lack of relevant research evidence from Cyprus on this issue, it is impossible to draw a direct inference as to whether citizens in Cyprus have a low sense of control and influence. This finding is consistent with the one other comprehensive implementation of Place Standard Tool in Cyprus that we are aware. The Action Plan for Nicosia’s historic center was developed by the Cyprus Energy Agency under the Sustainable Development of Historic Areas project of the European Climate – KIC. [45]. The interview sample of 221 people who live, work, or visit the area was also low in terms of influence and sense of control. Natural spaces came in second, which is not surprising considering the inner-city character of the surveyed area. The participants in the SUSHI study also rated aspects of the built environment lower than others. However, our findings show that the social environment and sense of safety were rated comparatively higher than all other items. According to Eurostat surveys, the perceptions of safety in Cyprus (in terms of crime, violence, and vandalism at the place of residence) has remained the same over the past decade (2010-2019), even though Cyprus is one of a few EU countries that has seen an increase in recorded homicides based on population size.

Although direct comparisons should not be made between settings, it’s worth noting that in the online Place Standard survey, Skopje, North Macedonia the citizen participation aspect was rated second to Traffic & Parking. [25]. Gjorgjev and colleagues. (2020) found that 55.4% of the 278 participants felt the need to make large improvements in this area (i.e. score of 1 or 2. [25]This is a comparable percentage to the 60.3% of participants in this study. The Skopje study contrasted the online Place Standard survey ratings and ratings obtained during focus group discussions with citizens and officials. Not surprisingly, focus group participants reported higher average scores in almost all dimensions than those who took part in the online survey. Although it is unclear from the studies whether the higher satisfaction among focus group participants can actually be attributed to the actual process, the authors concluded the Place Standard increased citizens’ knowledge and confidence and encouraged active participation in decision-making.

Horgan and Dimitrijevi (2019) recognize the importance of citizen participation and identify the need to foster social innovation [27]To quote: New solutions are more effective than existing solutions at meeting a social need simultaneously. They also lead to new or better relationships and capabilities, as well as better use and management of resources and assets. [46]to encourage collaborative and inclusive urban planning and placemaking. They discussed and compared the use of Place Standard with other place-based frameworks. They also focused on the implications of different approaches that include conventional (e.g. Face-to face use of Place Standard with citizens, stakeholder groups, and digital tools (such the Moscows Smart City Active Citizen portal) for community engagement in urban planning. The Active Citizen platform is an information-led platform that allows citizens to participate in decision-making. While they recognize the potential of these digital technologies, they also identified issues surrounding ownership, governance, and participation. They concluded that, to quote: While technology can be used to engage citizens on issues that have little impact on their day-to-day lives and future resilience, it is not a substitute for face-to-face engagement when decisions are needed on large issues like renovation or displacement. [27]. This statement is further supported and reinforced by the principles behind place-making. They are less about passive participation but more about active participation in a collaborative effort to co-create shared values, perceptions and traditions that give meaning to people and connect them to geographic space. [24]. Even in places with a longer history and a stronger tradition of place-based initiatives community empowerment requires great attention both to breadth and depth of participation [47].

The Place Standard Process Evaluation Report [18]Five case studies, each representing the first year of PST use in Scotland, are also presented. They cover a range of contexts and scales that facilitate community engagement and/or capacity-building with stakeholders (e.g. From small-scale planning that refers to a local town centre or housing rehabilitation project to larger strategic city planning decisions. These selected case studies describe a range of delivery methods. These selected case studies describe a variety of delivery methods, including open-door community focus groups and one-on-one walkabout consultations with citizens. They also include invited stakeholder workshops and wider online surveys. All cases identified the key challenges to successful implementation as encouraging citizen participation and ensuring inclusive reach across difficult-to-reach group. Another challenge was the active support of the senior management and different stakeholder groups. The Place Standard was adopted by many Scottish Local Authorities in their local planning practices. This may have helped practitioners understand the connections between place and health. A recent study suggests otherwise. [48]This increased awareness may not have been translated into formal Strategic Environmental Assessment practices in spatial planning. These practices may remain narrowly focused on environmental risk rather than being driven by a holistic view of the place effects on health.

Online surveys have the advantage of reaching more people. In the case of this study, participation was from all over the island despite the fact that the survey was only active for two weeks. This may suggest that there is potential for scaling up in the context a needs assessment exercise. However, it is unlikely that online surveys can promote participation, especially when they are a stand-alone activity like in our study. It is much more likely that an organized and iterative process driven in part by a coalition comprising academic institutions, local authorities, advocacy groups, and other organizations in the context broader community engagement and development. While large-scale canvassing can be helpful in gathering information and opinions that can guide planning, it is not a substitute for deeper engagement with communities. They have the potential to increase the reach in terms of absolute participation but it is not clear if this leads to a wider reach. And this is in contrast to the North Macedonia study [25]You can also view a number of case studies from Scotland [18]The Place Standard was only delivered online in our study, despite the fact that it was delivered in different formats. Future efforts should be focused on comparing different delivery formats and methods of community engagement for the PST (e.g. Online remote format vs face to-face group sessions, walk-abouts, or online) with a special focus on scale (e.g. Online remote format vs face-to-face group sessions or walkabouts) with a particular focus on scale (e.g., city-wide vs. specific neighbourhoods) and its implications for participation, engagement and inclusionness. Future studies should expand the scope of research beyond community profiling in order to gain a deeper understanding of the lived experience and social inequity within and across communities.

Limitations and strength

This is the first study to examine the residential environment in Cyprus. It depicts residents’ perceptions of various dimensions of the place that are important for their health and well-being. The voluntary participation means that selection bias cannot easily be ruled out. Low ratings across all dimensions may reflect people’s complaints about neighborhood problems. Although the sample is not representative, participation was from as many as five postcodes on the island. Participants were able to identify different neighbourhoods and their socio-demographic and social status. Because the study was intended to examine the dimensionality and diversity of the scale, it was important to collect responses from a wider range of neighbourhoods. In the majority cases, there were one to two responses per postcode. Mixed-models with random effects to reduce clustering at the neighbourhood level were not possible as there were only 50 participants. In future studies, it would be possible to collect opinions from a larger group of residents from a smaller number of neighbourhoods. This would allow us to explore the collective perceptions of residents about the same neighbourhood, and thus the ecometric properties, which includes the intra-neighbourhood deal. [9, 10, 12].

Census indicators were used to assess the extent to that neighbourhood ratings vary depending on the socio-demographic or built characteristics of the area. This is a strength of the study. Unfortunately, there are not many accepted indicators of social disadvantage in Cyprus so only a few indicators were considered. This was due to the limited availability of data. Not to be forgotten is that the definition of neighbourhood used by people may differ from the administrative ones. Although postcodes are the smallest geographic unit for which census data is available, they are likely to be more than what people consider their neighbourhood. Despite this, the study found a social gradient in neighbourhood environments. This was both measured by people’s perceptions of their neighbourhood’s social status compared to other residents and against a set objective indicators. Each lower level of the neighbourhood social status ladder was rated as having progressively worse neighbourhoods. A stepwise, but not nearly linear pattern was observed across the entire length of the social status continuum for all Place Standard items. Common method-source bias cannot necessarily be excluded as the assessment of neighbourhood social status was also self-reported. However, this could suggest that people, through a process called social comparison, consider all aspects of their neighborhood environment holistically. This is further supported by the stronger correlation between subjective social situation and the overall Place Standard score, which is higher than any one item.

Unfortunately, due to remote delivery, we were not able to gather feedback on the effectiveness of the Place Standard in our study. Future work should also consider the Place Standard as part of participatory learning or action research with diverse communities.

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