Leslie R. Carnahan, MPH; Kristine Zimmermann, MPH; Nadine R. Peacock, PhD Citation for this article: LR Carnahan, Carpenter K, NR Peacock...
Leslie R. Carnahan, MPH; Kristine Zimmermann, MPH; Nadine R. Peacock, PhD
Citation for this article: LR Carnahan, Carpenter K, NR Peacock. The fact that women in rural areas want the Community public health to know about access to healthy foods: a qualitative study, 2011. Back Chronic Dis 2016; 13: 150,583th DOI: http://dx.doi.org/10.5888/pcd13.150583.
Summary
introduction
Living in a rural food desert, he was associated with poor eating habits. to understand the community of perspectives on the available resources and possible solutions, can inform to improve food access in rural food deserts strategies. The aim of our study was to identify resources and solutions for food access problems of women in rural, southern Illinois.
Methods
Fourteen focus groups with women (n = 110 participants) in 4 age groups were concentrated 7 counties carried out as part of a community assessment on the health of women in an area. Content analysis with inductive and deductive methods are used to explore the barriers and facilitators of access to food.
Results
Similar participants to the participants in the study reported insufficient local food sources in previous studies, they believe contributed poor eating habits, high food prices and the need to move healthy foods. Participants identified local activities and resources that can help improve access, such as food banks in the town house, and transport, as well as local solutions, such as improving nutrition education and transport facilities existing audience.
graduation
Policies and measures at different levels and cooperation are needed to overcome obstacles to access to food in rural communities. At the individual level can help navigate the geographic and economic obstacles Education inhabitants. Community Solutions include cooperative strategies to increase the availability of healthy foods in non-traditional and traditional food sources. Policy change is necessary to promote in the private farming and distribution of locally grown foods. Understanding the needs and capacities of rural communities to ensure effective intervention strategies and to improve the rural environment of the food.
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introduction
culturally appropriate access to high quality food at affordable prices and at a reasonable distance of a residence has a positive association with the healthiest diets in the United States (1.2). Respect the recommended daily intake of fruits and vegetables is associated with a reduced risk in adults with multiple chronic diseases such as diabetes, hypertension and cardiovascular disease (2-5). But the inhabitants of rural areas of the United States can not meet the recommended intake of fruits and for many reasons in relation to access to food (6) vegetables. Obstacles to food access in rural areas are well documented and have high costs and long-distance traders of fresh products (1,2,7). Compared to urban food deserts rural food deserts fewer opportunities may have to address less diversity of food and fewer resources food safety (8.9).
Most of the literature focuses on the obstacles to the people in the countryside, no solutions or resources obtained (1,2,7). They came several programs to improve access to food for urban communities, but professional training for these programs have attracted many of the perception of urban residents and can not in the rural areas (10-13) to be translated. Our study was designed to address these gaps in the literature. The aim of our study was to identify resources and solutions for food access problems of women in rural, southern Illinois.
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Methods
produced The focus on assets (resources and solutions) data from focus groups to analyze where women were identified, resources and approach was used. We define the resources as factors as proposed or desired factors promote access and solutions that food to promote access to food. Perception of women access to food in terms of are important because women for buying food in household decisions and preparation (14,15) are often responsible. to understand the perspectives and contextual factors, an important step in the development of public health is to meet solutions for the needs of rural communities step.
. Configuration The Department of Health South Seven, the rural districts in Illinois South 7 (S7) is used, the identified obesity, diabetes, cardio - vascular - diseases, cancer and health as priority sectors (16). With higher than the overall rate Illinois, 70.6% of the S7 residents are overweight or obese (63.7% in Illinois), 11.7% reported diabetes (10.2% have in Illinois), are 34.4% said to have to have high blood pressure (30.1% in Illinois), and should have 46.6% high cholesterol (36.6% in Illinois) (17). In S7 counties only 15.4% of adults meeting the recommended daily fruit and vegetables (22.6% in Illinois) (17) reported. High rates of chronic diseases can be partly attributed not only of bad eating habits, but also lack of access to food. S7 Each county has at least one census tract as food desert identified (9).
For focus group and recruitment. Fourteen focus groups were conducted in the context of an overall assessment of Community Health to identify and discuss the health of women in S7 counties and the development of informed health programs in the region for women (18). Women were recruited with different sociodemographic (age, race, place of residence and socioeconomic status) using flyers, ads in churches, community newsletters, newspaper ads and functions. Those who the age and residency requirements were met invited to participate in focus groups in their communities. Before the beginning of each discussion group informed consent from each participant was obtained. University of Illinois at Chicago Institutional Review Board approved this research.
Focus group discussion groups procedures were in all districts S7 carried out in February and March 2011, ;. A place took in public places, places such as clinics, hospitals, churches, library and facilities high standard of living. Health educator local health department were trained as facilitators for the academic partners. Facilitators use, a semi-structured guide (see appendix) for the perception of communities and health needs of women. to deal with problems scripts for the ideas of the respondents to the questions and needs of more healthcare resources community health issues, and forces the community people to get health or recover to help. The questions were open, but sometimes interviewers suggested categories of health problems, solutions or strengths to stimulate reflection of respondents if the participants do not offer suggestions on their own. Focus group moderators were trained in facilitation methods and therefore use its own discretion to not be included in the guide focus group to promote additional sensors discussion. natural conversation is encouraged, but to stimulate the probes also detailed answers used and manage the discussions so that all topics were covered in an hour. Each participant received a gift card for $ 15 as an incentive. Focus group discussions were transcribed audiorecorded and shortly after completion. All reports were sent to the moderators to verify the accuracy and clarification. Before analysis, we check each transcript to your audio file.
Research methods and analysis - Team We performed a secondary analysis of data from focus groups to gather information about the additional public health.. was inductive content analysis to examine trends and issues of our data and used to develop a theory of perception of health among the participants related. deductive was content analysis, the barriers and facilitators of access used to explore food and use published data on food access in order to inform our conceptual framework; the data for the confirmation of the theory used. Although our analysis is based on data, we had a pre-established framework and the original interview guideline focus group included general questions, think how related to women in rural areas S7 and speak reflect health and behavior related. Two researchers trained both in qualitative research methods, led the analysis and interpretation of data from focus groups. A third high-level qualitative research provides supervision and guidance. First revised and annotated the 14 transcripts, first ideas about the content of questions relevant to the research of the recording. This enlightened opinion of the development of a number of codes in a systematic analysis software that uses provided by the analysis of qualitative data available (ATLAS.ti, version 7; Scientific Software Development GmbH). We document our analysis using a detailed audit trail. Then the principles of the analysis of the constant comparison to use, we have our problems reporting threshold codebook expanded data accounts (19). A subset of transcripts were coded by two team members. Then we discuss discrepancies and encoding the codebook to change to clarify the concepts and code definitions. The process was repeated several times to create the final code-book. Our newest book code consisted of 45 codes, divided into 8 encoding families: access, demography, environment, food, health, healthcare, illness and disease, and physical activity.
With filled codebooks coded transcripts segmented independently κ by calculation and Cohen level. The process was repeated several times until an acceptable agreement score to reach (gross agreement = 98.1%, with a mean κ = 0.89). Following an agreement, a researcher codifies the remaining transcripts. During team meetings, general issues were identified for further exploration. the codes were selected for these topics, and the search function ATLAS.ti (Query Tool) is used, the relevant section (Dating) are retrieved. They were independently verified consultations and examined detailed interpretative notes. During the regular team meetings, we discussed our preliminary results, and we have further consultations had to confirm and establish the themes.
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Results
A total of 110 women participated in 14 focus groups (Table 1); the average number per group participants was (3-13 women section). 7 Seventy-nine (71.8%) of the participants were white, and 31 (28.2%) were African American. Thirty percent of participants (n = 33), 70 years or older.
Participants identified, physical social and economic food, especially in the purchase of food they described (Table 2) sound barriers. Participants indicated that their communities for local businesses had an insufficient number of supply and travel times that sell affordable food and quality local businesses, such as fresh fruits and vegetables were too large. Some women discuss alternatives to grocery stores, such as gas stations, convenience stores and fast-food restaurants; However, they said that alternatives often lack healthy choices. low income was also identified as a barrier to access to healthy foods. As bad challenges aggravated local food supplies and travel outside the community access to healthy food to have. general rules of society has also affected access. Due to the various tasks at home and work outside the home, women had little time and energy. Due to competing priorities, some were not able to spend time position in the preparation of meals and pressed the fast food and eat outside.
Participants described many existing and proposed solutions to food access problems (Table 3). , Community gardens and school staff have been described as existing and proposed measures to improve access to food solutions, because they were seen as a way to fill the gaps, which provides by the local grocery store to fill fresh food and attractive to consumers. Some participants described with garden vegetable gardens share the opportunities that gave with friends, neighbors and other community members, and others, it regularly Food keeps access these foods from their gardens if gardening was not possible. They proposed as a quick and healthy solutions to increase the community classes on gardening, food preservation (eg canned), and cooking local access to healthy food. One participant suggested to create a market for community members to distribute and sell their excess production.
Participants were two public transport companies, alleviate the traffic problems in the region S7. For people homebound, describe women, the delivery of programs of food products, such as meals on wheels to serve in the region. Several participants suggested that the public transport services could be extended to help residents access to grocery stores and supermarkets.
Participants discussed a range of resources and access to food particularly relevant solutions for low-income populations. Many describe a feeling of a close-knit community and altruistic actions. For example, religious and charitable organizations distribute food to people through local food banks and food services. The participants suggested that community resources for low-income people should give more publicity to educate the community.
The participants also proposed solutions in terms of citizens' groups and political change in their communities to increase access to food. For example, they suggested that members of the community coalitions problems to reduce food-related access. The participants suggested also with government officials about the impact of cuts in food supplements and utilities expressing concern.
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discussion
This study contributes to the limited research on the perception of women in the access to food and healthy solutions for inadequate problem of access to food in rural communities. Our results suggest that the rural communities as S7 Illinois region have enough local sources of healthy eating, to move a contribution to poor eating habits and the need for healthy food. The need to travel is a burden for the population groups who have difficulty in accessing the transport (eg low-income residents). In addition, women who work and are often responsible for purchasing and cooking can be placed also by the lack of local access to healthy food in their communities in accounting that may affect their own eating habits and their families.
The focus group participants mentioned local activities (eg gardening and hunting) and local resources (eg, food banks and transport) as a means to improve access to food. However, these resources were perceived to be inadequate to meet the needs access all residents on food because they are not suitable or appropriate for all S7 residents and resources are not available in all parts of S7-site activities. Therefore they have to be coordinated, different levels of collaborative strategies to increase access. At the individual level are to change behavior interventions and educational strategies that have been associated with positive changes in eating patterns, implemented to mitigate the geographic and economic barriers to access to food (20,21). Education is mentioned as existing resource and the proposed solution, on topics such as gardening, food preservation, produce life and healthy fresh products (eg canned, frozen) alternatives could reduce dependence on local shops and reduce the frequent travel required. Training in the production of fast food, easy and healthy to reduce the range of possibilities and options available, the consumption of fast food and to improve the eating habits (22). Federal, as the US Department of Agriculture and the Centers for Disease Control and prevention of disease, toolkits and resources that can be used for educational purposes agencies. The American Dietetic Association recommends including food and nutrition education programs that address food insecurity (23). Also recognized as group members that S7 residents consume fast food, raise awareness of rapid and healthy food choices can help rural residents to make healthier choices. collaborative application of these strategies in community-based environments to maximize coverage.
Improving the food environment, if done especially in conjunction with educational strategies, has the potential for greater impact in rural communities, health education strategies in single individual. existing community resources in the S7 counties include farmers markets, food banks, faith-based and other organizations, the meals, community and school gardens offer. Innovation and cooperation, including grocery stores, gas stations, convenience stores and can spot help increase the availability of healthy food options. For example, could small businesses with common food distributor Collaborate food in bulk at a lower price to buy, when they buy individually to eat and then sell it to customers at a lower price. In addition, the stores could work grow locally with farmers in the region and produce food, to offer healthy choices, locally sourced. Shops can also undertake healthier products for sale to provide. Working with local stores to promote sales of healthy food with demonstrations and distribution of healthy recipes for food preparation are combined. Moreover, research shows 1) that the owners are susceptible to stores rural corner store healthy foods like fruits and vegetables, and 2) that customers are willing to buy (24).
More organic food to grow locally and affordable are the collection and distribution of fresh products such as the excess garden, through strategies for local food banks. This strategy would require the provision of equipment for the food banks for the handling and storage of perishable goods. Previous food bank efforts to have access to and consumption of fruits and vegetables increased (12). Fast food banks can also (10.13) are contemplated. In addition, innovative programs to reduce food waste and recovery could also promote access to food. These new models are excess food in stores and grocery stores restaurants to people redistributed from food insecurity suffer (25). local food producers could also fresh and healthy food for sale on local agricultural markets (26), are conveyed. religious and community organizations, such as resources, described by focus groups, to form programs or coalitions support that address access to food, because they are often points of natural resources and the associated health are rural communities (26,27). Change the policy of food access in the context should be taken into consideration (28-30). Guidelines, codes and zoning regulations need to be created, modified or revised in order to promote the distribution and sale of local food. When you do this, you can ensure that farms, food production and farmers' markets are able to operate at the neighborhood level.
This study has several limitations. First participants not chosen randomly. Although a wide range of age included, participants may not fully represent the diversity in the southern tip of Illinois. In addition, some participants worked in health care or social services fields that have influenced their views on the town health needs. Some participants have already participated in a community intervention, the risk of cardiovascular disease to reduce that, their answers may be biased on feeding behavior. In addition, since the focus groups are limited to women, the answers to both men and children in the region can not be generalized can. Finally, we focus groups to understand the general perception of women about their health needs and not their perception of access to food, in particular. However, participants debate on access to food suggest that it is an important subject.
Our findings suggest that more research is needed to assess the landscape of rural food deserts and learn about food availability, cost and purchase behavior. The impact of community gardens, school gardens and farmers markets in rural communities access to food material should also be taken into consideration. The benefit of alternative access points such as gas stations and grocery stores should be investigated because they may be viable alternatives in rural and low-density with limited access to food. Furthermore, the integration could be examined alternatives to new options such as frozen fruits and vegetables in rural diets.
Given the rising rates of chronic disease in the United States, the understanding of the relationship between access to food and chronic diseases of public health practitioners can better help you understand how the needs to be addressed to community and individual. We also need to consider the impact of food deserts beyond the distance needed to travel and the availability of food. The impact of food deserts in access to food is also linked to social and economic factors. Interventions and measures food access in rural food to increase deserts to take this social and economic factors. Moreover, to understand visions of a healthy environment communities of food "will ensure that future researchers are looking for ways to affordable food, culturally appropriate and high quality at a reasonable distance from homes. Can solve not only approach the problem. Comprehensive public health researchers and practitioners should consider a combination of changes in the structure, economic and individual appropriate to reduce the negative health effects caused by rural behavior food deserts.
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thanks
We thank the members of the Southern Seven Health Coalition of Women for planning and conducting focus groups and for their continued support of health initiatives for women in the southern tip of Illinois. This article was prepared by grant no. 1CCEWH101009-01-00 and 1CCEWH111024-01-00 Ministry of Health and Social Services for Women's Health (OWH). Its content is the sole responsibility of the authors and do not necessarily reflect the official views of the OWH, the Office of the Assistant Secretary for Health, or the Ministry of Health and the rights of the United States represent.
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Author information
Corresponding Author: Leslie R. Carnahan, MPH, of the Center for Women's Studies and Gender, University of Illinois at Chicago, 1640 West Roosevelt Rd, Chicago, IL 60608th Phone: 312- 355 3880 E- mail: lcarna2@uic.edu ,
Affiliations Author: Kristine Zimmermann, the Women's Research and equality and the School of Public Health at the University of Illinois at Chicago, Chicago, Illinois; Nadine R. Peacock, School of Public Health at the University of Illinois at Chicago, Chicago, Illinois. Mrs. Carnahan is also affiliated with the School of Public Health at the University of Illinois at Chicago, Chicago, Illinois.
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credentials
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Mesas
Tabla 1. CaracterÃsticas demográficas de los grupos de enfoque participantes (n = 110), el estudio entre las mujeres sobre el acceso a alimentos saludables en los 7 condados más al sur de Illinois de 2011
| CaracterÃstica | n (%) |
|---|---|
| Carrera | |
| afroamericano | 31 (28.2) |
| White | 79 (71.8) |
| etnicidad | |
| Hispano | 2 (1,8) |
| Grupo de edad, y | |
| 18-30 | 26 (23.6) |
| 31-50 | 24 (21.8) |
| 51-70 | 27 (24.6) |
| ≥70 | 33 (30.0) |
| PaÃs de residencia | |
| Alexander | 27 (24.5) |
| Johnson | 9 (8.2) |
| massac | 9 (8.2) |
| Papa o un Hardin | 31 (28.2) |
| Pulaski | 18 (16.4) |
| Unión | 16 (14.5) |
Debido a un pequeño tamaño de las poblaciones, se combinaron los grupos de enfoque en condados del papa y Hardin.
Tabla 2. Citas de ejemplo en las barreras de acceso a los alimentos saludable, por Subtema, De los grupos de enfoque participantes (n = 110), Estudio sobre el acceso a alimentos saludables en los 7 condados más al sur de Illinois de 2011
| Subtema, el condado, grupo de edad | commentaire |
|---|---|
| Las barreras fÃsicas | |
| Papa o Hardin, edades 31-50 y | Tenemos una tienda de comestibles aquà que usted puede conseguir producir a partir de, ya sabes, no tenemos acceso. Tienes que conducir. , , 45 minutos para obtener un buen producto. Por lo tanto, las cosas que son. , , sano, no tenemos acceso a, acceso inmediato a. |
| Las barreras económicas | |
| Papa o Hardin, edades 18-30 y | Sólo podemos darnos el lujo de ir a la tienda de comestibles, ya sabes, una vez cada 2 semanas más o menos. Asà que no es como que está recibiendo los productos frescos, no es que se puede mantener en la casa tanto tiempo. |
| Unión, edades 31-50 Y | frutas y verduras frescas y cosas por el estilo son mucho más caros y si las familias no pueden permitir, a continuación, que están comprando los alimentos procesados que son mucho más baratos. |
| Las barreras sociales | |
| Massac, edades 51-70 Y | Usted sabe que el estilo de vida de la gente ha cambiado. Las mujeres trabajan fuera de la casa, cuando solÃan quedarse en casa y preparar mejor las comidas. Ahora vamos todos a comer debido a que más mujeres trabajan fuera de la casa. |
| Alexander, edades y ≥70 | Una gran cantidad de personas que no tienen parientes que les llevará a la tienda de comestibles, o amigos, entonces ellos tienen que depender de otras personas, y pagar, y mucho. |
| otras barreras | |
| Alexander, edades 31-50 Y | Participante 1: Quiero decir, he ido a las tiendas de comestibles, y yo mirado a los vegetales, y yo soy como, "Están vendiendo esto?" Participante 2: Bueno, es mohosa! En realidad se puede encontrar molde. Participante 1: Es horrible. |
| Pulaski, edades 18-30 Y | Tiene como frutas y otras cosas como las manzanas, que tienen moretones, plátanos, consiguen madura después como 2 semanas, o se puede comprar como una cosa de galletas Oreo, van a durar unos pocos meses. , , y luego las galletas Oreo cuestan menos que las manzanas y las cosas para que duren más tiempo. |
a Because of small population sizes, the focus groups in Pope and Hardin counties were combined.
Table 3. Existing Resources and Proposed Solutions at the Individual, Community, and Policy Levels to Eliminate Barriers to Healthful Food Access: Sample Quotations from Study on Access to Healthful Foods in the 7 Southernmost Counties of Illinois, 2011
| Nivel | Subtheme a | Quotes Representative of Subtheme b |
|---|---|---|
| individual |
|
|
| Comunidad |
|
|
| PolÃtica |
|
|
Abbreviations: R, resource (existing); S, solution (proposed).
a Resources and solutions proposed by participants may overlap because of the geographic scope of the focus groups and because some counties may not have a resource that exists in another county.
b Respondent identified by county of residence and age group.
c Because of small population sizes, the focus groups in Pope and Hardin counties were combined.
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Appendix: Focus Group Guide
Ice Breaker Instructions for the Facilitator
Before participants arrive, spread the ice breaker pictures on a table. As participants come in welcome them, direct them to the refreshments, and give them instructions for the icebreaker exercise. This will give participants something to do while the women gather. Say to participants, "We are going to do an exercise using the pictures on the table. I would like you to pick up any 2 pictures from the table that represent health to you. Once you find 2 pictures you can take a seat, and we will get started once everyone is seated."
Ice Breaker Exercise (no more than 15 mins)
To start, I would like to ask each of you to introduce yourself and tell us why you were interested in coming to this meeting. Then show us the pictures you chose and tell us what they mean to you – how they represent health to you. So that we have time to complete the whole discussion I will ask each of you to limit yourselves to 2-3 minutes.
Healthy Communities and Women's Health
Now I would like to get your perspectives about the health and health needs of the Southern Seven population in general and women in particular.
What does health mean to you as a woman? Think about your various roles as a woman – a mother, daughter, wife, grandmother, sister, aunt, friend, etc.
I am going to ask you some questions about your "community." A "community" can be a group of people that live in the same geographical location, or it can be a group of people with similar interests or characteristics, such as race, age, or occupation. A community can be the people living in a town, members of a church or club, students that attend a particular school – or their parents, people who work at a particular location, people who regularly shop at a particular store, eat at a particular restaurant, or receive services at a particular hospital or clinic. You probably belong to more than one community. For the next part of the discussion, think about one community that you are a part of that is located within the southern seven counties.
[ Clarification for facilitator: we don't want them talking about online communities. ]
What do you consider to be your community?
What do you think are important characteristics or features of a healthy community?
Health Needs of the Community
What do you think are the most significant health needs or health problems in your community?
[ Have the co-facilitator list these on a flip chart. ]
What do you think are the causes of the health problems that you mentioned?
How are women affected by these needs or problems?
Is there anything being done to solve the health problems that you talked about? Could you explain?
Do you think more can be done? What kinds of things can be done?
The Southern Seven Health Department recently identified heart disease, obesity, diabetes and cancer as health conditions that need to be addressed in your region. Do you think these are important issues to be addressed? [Probe: why or why not?]
a.What do you think can be done to prevent these health conditions, and/or to help individuals who are affected by these health conditions?
b.Are there specific activities/services that can be targeted to women?
Are there health needs or health concerns that specifically affect young girls or teen girls in your community? [Probe for detail.]
[ Have the co-facilitator list these on a flip chart. ]
What do you think are the causes of the health concerns that you mentioned?
Access to Health Care
Does everyone in your community have access to health care services that they need? If not, which groups do not have access and why?
Community Strengths
What do you see as the strengths in your community that can help people be healthy or stay healthy? [Prompts: Are there services, organizations, resources, facilities?]
Closing
Before we end, does anyone have anything they would like to add to the discussion? Or, does anyone have questions for me? Thank you for taking the time to participate!
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The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions.
