Understanding and addressing barriers to implementation of environmental and policy interventions to support physical activity and healthy eating in rural communities

Rural residents are at greater risk of obesity than urban and suburban residents. Failure to meet physical activity and healthy eating recommendations play a role. Although evidence about the effectiveness of environmental and policy interventions to promote physical activity and healthy eating is growing, little is known about which interventions are effective in rural areas. The purpose of this study was to identify types of environmental and policy interventions being implemented in rural communities to promote physical activity and/or healthy eating, identify barriers to implementation of these interventions, and identify strategies rural communities have used to overcome these barriers. Key informant interviews with a purposive sample of public health professionals working in rural areas in the United States were conducted in 2010. The sample included 15 public health practitioners engaged in planning, implementing, or evaluating environmental or policy interventions to promote physical activity or healthy eating in a rural community. Our findings reveal that barriers in rural communities include cultural differences, population size, limited human capital, and difficulty demonstrating the connection between social and economic policy and health outcomes. Key informants identified a number of strategies to overcome these barriers such as developing broad based partnerships and building on the existing infrastructure. Our research suggests that environmental and policy interventions to promote physical activity and healthy eating in rural communities have great potential to improve behavior within rural communities. To realize these outcomes rural communities need to adapt these types of interventions to their unique context and document their effectiveness.