Living in a Choice Environment: Empowering Women to Make Sustainable Behavioral Changes

Background: In Utah, rates of obesity for individuals in minority populations can be more than double the rates for non-Hispanic whites. This disparity is especially pronounced for women. Public health interventions that focus only on behavioral changes may have short-term results. Consideration of the underlying social and cultural determinants may be the key to long-term success and sustained improvements in health behaviors. Methods: In 2011, the Utah Women's Health Coalition partnered with Community Faces of Utah (CFU) to conduct focus groups to identify the fundamental challenges to weight loss experienced by women in underserved communities. CFU is a coalition representing five diverse populations (Africans, African Americans, American Indians, Hispanic/Latinos, and Pacific Islanders). A series of discussions were held using a community-based participatory research approach. Twelve women participated in each discussion (n=60). Results: Common themes crossed all communities. Women's food selections may be restricted by their husband's preferences or his imposed budget. Men often select family activities that limit women's exercise time. Low income intensifies women's lack of choice. Nevertheless, women are viewed as role models and responsible for the family's health. Both coalitions are using focus group findings to develop interventions to empower women to overcome the subordinating effects of their social norms. Conclusions: Interventions can educate women about lifestyle choices, but without a supportive environment, changes may not be sustainable. Understanding the social determinants that influence choice is essential if the interventions are to be successful. Addressing the environmental context may be especially important for women in disadvantaged communities.