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The Seniors’ Outdoor Survey (SOS Tool): comparing ratings and reliability between Italy and the USA

ABSTRACT To test applicability of an environmental assessment instrument in new settings, the ratings and reliability of the SOS Tool were compared in diverse settings with a similar climate: Milan, Italy; and Bryan/College Station, Texas, USA. This instrument evaluates physical environment support for outdoor usage by residents at senior facilities. Two trained raters assigned ratings (using a 1–7 scale) to the 60 instrument items at each setting (Italy: 94 outdoor spaces, 67 facilities; US: 22 outdoor spaces, 12 facilities). Overall mean ratings were similar across both sites (6% difference), and three of the five domains had comparable mean ratings. Mean inter-rater reliability was good in both settings but higher in Italy (ICC = .97 versus .82). Despite geographic/cultural differences, mean ratings for most items and domains were surprisingly similar between Italy and the US. This finding, and the high inter-rater reliability found in both settings, suggest this instrument may be useful in a wide range of settings.