领域：学术论文 · 社会科学

"Climate change and weather-related hazards are known to adversely impact environmental determinants of human health such as air quality, water quality, food systems, and the built environment [1]. An additional 250,000 annual climate-related deaths are expected globally between 2030 and 2050 due to malnutrition, malaria, diarrhea, and heat stress—most of these deaths are predicted to occur in low- and middle-income countries (LMICs) [2]. Compounded with socio-economic challenges, climate change is likely to pose the greatest consequences to those in low-income settings, who are least likely to contribute to climate change [3, 4].

Low-income urban communities, especially those in LMICs, are vulnerable to climate change. These populations have less access to services, lower-quality and infrequently maintained infrastructure, and degraded natural environments and ecosystems as compared to urban areas in high-income communities/countries [5]. These inequalities in services, infrastructure, and environmental capital are a product of historical and systemic exploitation by the global north and further exacerbated by socio-economic marginalization and insufficient social welfare funding [6,7,8,9,10].

There has been an increase in urban informal settlements due to rapid and unplanned urbanization, especially in Asia and sub-Saharan Africa [11]. Generally located in more inhospitable parts of urban areas, informal settlements have no tenure security, are cut off from formal, basic services, and housing infrastructure may not comply with current planning and building regulations [12]. Urban poor communities and residents of informal settlements are vulnerable to a variety of environmental disturbances but unlike higher income settings, lack consistent and dependable resources to cope with such disturbances [5]. Global estimates from 2020 suggest over one billion people are living in either slums or other informal settlements and currently lack adequate and affordable housing. The number is expected to grow by 200 million or 20% by 2030 [13]. With a worsening climate, there is an urgent need to build resilience among these vulnerable populations [14].

Resilient households and communities are better able to cope with shocks and stressors—disruptive events or the risk of such events [15]—which leads to more efficient and timely recovery [16]. Resilience is the capacity of a system to cope with, absorb, and adapt to a changing environment and resulting disturbances, while also incorporating the ability to reorganize, learn from past experiences, and transform for future challenges [17,18,19]. Resilience is often considered in terms of the following capacities: “(1) absorptive capacity—the ability to minimize exposure to shocks and recover quickly when exposed; (2) adaptive capacity—the ability to make informed choices about alternative livelihood strategies based on changing conditions; and (3) transformative capacity—system-level enabling conditions for lasting resilience” [19]. There is a growing interest in building resilience among urban households and informal settlements [20]. However, there is limited evidence for resilience-building strategies, especially among urban households in LMICs and informal settlements.

A reliable and valid resilience measurement tool is needed to track progress and generate evidence towards building resilience in the face of environmental disturbances. However, resilience is a latent construct, meaning it is not directly observable or quantifiable, posing measurement challenges [21]. Existing measures often rely on direct observation, overlooking the latent nature of resilience [22]. While there is a strong theoretical foundation for resilience measurement and conceptualization, resilience frameworks require additional specificity to be applied for measures. This poses a challenge as resilience is context-specific, influenced by the system of interest (resilience of what), relevant shocks/stressors (resilience to what), and the population and cultural context (resilience by whom) [23]. There is little guidance on how to transform generalized frameworks into context-specific and field applicable tools/methods such as surveys and quantitative analyses. Limited resilience measurement data impedes the ability to test underlying theory and assess current programmatic approaches to building resilience [24]. Among the limited practical tools available, many have not retained the theoretical underpinnings of resilience measurement, often conflating resilience with concepts like vulnerability and mere counting of assets [25,26,27,28].

To address these challenges, we developed and validated scales measuring urban household resilience to environmental shocks/stressors in LMICs. The scales were internally validated using additionally collected data on topics such as financial satisfaction and community satisfaction and safety. The scales capture the latent construct of resilience through survey questions that assess the ability to cope, recover, and overcome relevant disturbances. This paper details the process from survey drafting to scale development and psychometric evaluation.

Our scales were developed within the ongoing Revitalizing Informal Settlements and their Environments (RISE) study, a randomized control trial across 24 informal settlements in Makassar, Indonesia and Suva, Fiji. RISE adopts a water-sensitive approach to site-specific water and sanitation infrastructure, aiming to reduce flooding hazards and fecal contamination and improve human health (see more on study design in Leder et al.) [29]. While not explicitly designed to improve household resilience, the participatory design approach has the potential to affect resilience through changes in social capital [30], and infrastructural interventions can affect resilience through water supply diversification and flood management [31, 32]. Resilience data produced by our study serves not only to test a previously developed theoretical resilience framework[25] but will also be used to assess the effect of the RISE program on resilience among participating informal settlements.

Bahasa Indonesia and iTaukei (Fijian) translations of the abstract are provided in Additional File 1.

Methods

We developed three separate scales to measure economic, environmental, and social urban household resilience to environmental disturbances. We used factor analysis and item response theory (IRT) methods to evaluate the factor structure and measurement properties of the scales. Additionally, we assessed the scales’ internal validity and reliability.

The RISE trial

Our study was conducted within RISE study, an on-going randomized control trial being conducted across 24 informal settlements in Suva, Fiji and Makassar, Indonesia with six intervention and six control settlements in each country (inception in 2017) (Additional file 1: Fig S1). Specifics of the intervention can be found in Leder et al., Francis et al., and the RISE Knowledge Product Series [29, 33,34,35,36]. Briefly, RISE uses a water-sensitive approach to participatory design of site-specific, modular, and decentralized water and sanitation infrastructural interventions. The central hypothesis of RISE is that these water-sensitive interventions will decrease environmental fecal contamination and flooding hazards, resulting overall in reduced human exposure to fecal contamination, and thus, improved human and ecological health and well-being. The infrastructural intervention includes wet pods (toilets, hand basins, rainwater tanks); pressure sewer systems; and wastewater treatment via constructed wetlands and biofilters. Stormwater management features revitalized drains, rain gardens, and permeable pavement, while flood mitigation includes backflow prevention, terrain modification, and protection walls. Water security is enhanced through municipal connections, rainwater harvesting, and well protection, with raised pathways improving road access in flood-prone areas.

Household resilience scale development within the RISE study

To measure potential impacts of the RISE intervention on household resilience, we developed survey questions that were embedded in the September 2022 household survey (prior to the start of intervention build), which we refer to as the “main” survey throughout this paper. The rest of the methods section details our process on survey question development, data collection, scale development, further scale evaluation, and scale validation, which are in line with best practices [22, 37].

Development of an urban household resilience framework for LMICs

For our a priori framework, we adapted the household resilience measurement framework developed in Serfillipi et al. [38]. We chose this framework as it was well grounded in resilience theory, being the result of a literature review and synthesis of 13 resilience frameworks [38]. We removed elements that would only pertain to rural or agricultural settings to create an adapted framework that would pertain to an urban environment. We further adapted the framework to make it more context-specific, based on the results of our scoping review of household and community resilience to environmental shocks and stressors in coastal urban environments in LMICs [25]. Because this framework consisted of three domains (economic, environmental, and social resilience), we chose to develop three separate resilience measurement scales, one for each of the three domains. While resilience is inherently multidimensional, with economic, environmental, and social resilience interacting to shape a household’s overall capacity to cope with disturbances, we developed separate measurement scales for each to enable independent assessment of the factors influencing each aspect of resilience.

Survey question development

We designed the resilience module survey questions based on an adapted framework for urban household resilience measurement in LMICs, which we developed and published through a scoping review [25]. This framework guided the selection and development of survey items to capture key sub-domains, capitals, and capacities relevant to resilience in these settings. The majority of survey items were newly developed based on this framework, and five items were adapted from the regularly deployed main RISE household survey. For example, the Household Water Insecurity Experience (HWISE) scale [39], which consists of four survey questions, was already present in the main RISE survey and was therefore also used within the environmental resilience domain questions. Table S1 details the preliminary survey questions by resilience framework domain and sub-domain, indicating whether they were newly designed or adapted from the existing RISE survey. The surveys were translated into the local languages (Bahasa Indonesia for Indonesia and iTaukei for Fiji) and back-translated to English to ensure accuracy and consistency (Additional File 1: Table S1).

We carried out cognitive interviews with our new survey questions to identify and revise questions that may be unclear, ambiguous, difficult, or not understood as intended [40]. These cognitive interviews were also conducted to ensure the survey questions reflected the experiences of the current study population, and to identify potentially irrelevant questions and revise questions to better fit the context (see Additional file 1: Table S1). The goal of cognitive interviews is to reveal issues that respondents might have with survey item content or context, understanding of the items, and retrieving and integrating personal information and experiences to answer the item. Cognitive interviews are also used to reveal issues regarding sequencing, item length, sensitivity, problematic or irrelevant response options, inappropriate vocabulary, and temporal and spatial confusion [41].

We conducted six cognitive interviews with our Indonesian team members virtually via Zoom (due to COVID-19 restrictions) and nine cognitive interviews with our team members in Fiji (in person) using our first draft of survey items. During the interviews, we asked each new survey question to a staff member, recorded their response, and then followed up with additional questions to better understand how they arrived at their answer. While it is recommended to pilot survey questions with a subset of the study population, we opted to pilot our questions with staff members to minimize survey fatigue among community members. Prior to the interviews, we met with all participating in-country team members to explain the purpose of the interviews; we instructed the team members to answer the survey questions as if they were members of the RISE communities. The RISE team members that were chosen to participate in these cognitive interviews are residents of Indonesia and Fiji, and many have been working with RISE for several years. The chosen staff members have the background knowledge and cultural context of their respective countries and were able to advise on the appropriateness of the question wording, vocabulary, and translations (see Additional file 2). Survey items were revised after approximately every three interviews. After completing all the interviews, we reconvened with the RISE team members and went through each revised survey question to discuss any outstanding issues before finalizing the survey items."

翻译考点：
考点1： "environmental determinants of human health" 应译为 "人类健康的环境决定因素"  
考点2： "Compounded with" 应译为 "与…… 叠加" / "与……交织加剧"  
考点3： "historical and systemic exploitation by the global north" 应译为 "全球北方国家的历史性和系统性剥削"  
考点4： "tenure security" 应译为 "居住权保障" / "土地保有权保障"  
考点5： "shocks and stressors" 应译为 "冲击与压力源"  
考点6： "absorptive capacity, adaptive capacity, transformative capacity" 应译为 "吸收能力、适应能力、转型能力"  
考点7： "latent construct" 应译为 "潜在构念"  
考点8： "wet pods" 应译为 "湿舱" / "集成式卫浴单元"  
考点9： "constructed wetlands and biofilters" 应译为 "人工湿地和生物滤池"  
考点10： "scoping review" 应译为 "范围综述" / "范畴综述"  
考点11： "back-translated to English" 应译为 "回译成英文"  
考点12： "factor analysis and item response theory (IRT)" 应译为 "因子分析与项目反应理论"  
考点13： "site-specific water and sanitation infrastructure" 应译为 "场地特定的水与卫生基础设施"  
考点14： "flood mitigation" 应译为 "防洪缓解措施"