Perspectives on Healthy Eating Among Appalachian Residents

Abstract

Purpose Extensive attention has been focused on improving the dietary intake of Americans. Such focus is warranted due to increasing rates of overweight, obesity, and other dietary-related disease. To address suboptimal dietary intake requires an improved, contextualized understanding of the multiple and intersecting influences on healthy eating, particularly among those populations at greatest risk of and from poor diet, including rural residents. Methods During 8 focus groups (N=99) and 6 group key informant interviews (N=20), diverse Appalachian rural residents were queried about their perceptions of healthy eating, determinants of healthy food intake, and recommendations for improving the dietary intake of people in their communities. Participants included church members and other laypeople, public health officials, social service providers, health care professionals, and others. Findings Participants offered insights on healthy eating consistent with the categories of individual, interpersonal, community, physical, environmental and society-level influences described in the socioecological model. Although many participants identified gaps in dietary knowledge as a persistent problem, informants also identified extra-individual factors, including the influence of family, fellow church members, and schools, policy, advertising and media, and general societal trends, as challenges to healthy dietary intake. We highlight Appalachian residents’ recommendations for promoting healthier diets, including support groups, educational workshops, cooking classes, and community gardening. Conclusions We discuss the implications of these findings for programmatic development in the Appalachian context.

Retail Food Store Access in Rural Appalachia: A Mixed Methods Study

“…Residents of rural communities often face added economic challenges of food insecurity and unemployment (Appalachian Regional Commission, ). Research on Appalachian adults’ food choices has found that food knowledge, intra‐family norms, and community social networks influence food choices (Schoenberg, Howell, Swanson, Grosh, & Bardach, ). These multilevel influences underscore the importance of assessing food access from a socio‐ecological perspective, including the individual (consumer) and community food environment.…”

Attitudes, social norms and perceived behavioral control factors influencing participation in a cooking skills program in rural Central Appalachia

“…Despite the low number of class participants, the nominal group sessions conducted prior to intervention development revealed barriers and enhancements to healthy eating that paralleled motivation to participate in cooking classes (13). Subsequent focus group research in Appalachia has reported similar findings (27). Additional qualitative, quantitative and mixed methods studies reflect the importance of pre-intervention assessment of the barriers to and facilitators of healthy eating in several populations worldwide (28–39).…”

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“…Questionnaire responses indicated general impressions of specific aspects of each theme validated in the Rural Nutrition Care Model. 15 Some sample questionnaire topics can be found in Gutschall et al 16 or by writing the lead author of this article.…”

“…15 Residents there identify the need for modified health behaviors and improved quality health care in Appalachia. 11,16 A complete understanding of the local culture could help serve this population's health care and nutrition needs, 17 whereas violation of these cultural norms may create additional barriers to meeting those needs. Adequate and accurate nutrition information is critically important in a region plagued by chronic disease.…”