JMIR Publications

ABSTRACT

Background:

Dementia is a progressive neurocognitive syndrome and a major global public health issue caused by an ageing population. As the number of people living with dementia (PlwD) continues to rise, it is increasingly recognised that dementia care must extend beyond clinical care to encompass social well-being, autonomy and quality of life. This study developed a method to assess the degree to which neighbourhood-built environments support the wayfinding and social health of PlwD and evaluated the feasibility and reliability of using virtual 360-degree imagery alongside a structured environmental checklist that was developed by synthesising thematic evidence and existing dementia-friendly design checklists.

Objective:

To address these objectives, a mixed-methods design was applied, combining a quantitative cross-sectional assessment with qualitative interviews.

Methods:

A 35-item checklist was applied to virtual 360-degree imagery, with inter-rater reliability assessed in a subsample of 335 observations using Cohen's kappa and Gwet's AC1. Semi-structured interviews were conducted with six PlwD and six care partners (CP) and analysed using qualitative content analysis. Of 135 assessed items, 43 showed at least substantial agreement with both reliability coefficients.

Results:

Reliability was particularly high for clearly observable infrastructural features, whereas interpretative wayfinding features showed lower and more variable agreement. Qualitative analysis identified 15 categories and 57 subcategories describing environmental features associated with social health.

Conclusions:

Overall, findings highlight the importance of neighbourhoods that are accessible, legible, safe, and socially supportive for independence, participation, and meaningful social engagement. However, they also suggest that these objective environmental assessments should be complemented by participatory approaches to capture the broader experiential dimensions of social health among PlwD.