Factors affecting food choices in lower-income rural Appalachian residents

Background: Significant health disparities and poverty in the Appalachian region create urgency to improve social determinants of obesity, diabetes, and other diet-related diseases. Greater understanding of social and cultural influences on dietary behaviors in Appalachia is essential to inform effective public health nursing interventions. This study examines rural Appalachian women's experiences as consumers and household food managers in accessing and making choices about food. Methods: Twenty women with at least one child at home living in a rural Central Appalachian county will comprise the sample. A focused ethnographic approach consisting of three interview sessions with each participant is used to understand social systems, norms, values, and behaviors. The sequence of interviews includes a set of questionnaires on household resources, food security, and travel patterns; a go-along interview to a grocery store to observe interactions with the food environment; and a semistructured interview to elicit detailed descriptions of factors affecting food shopping choices. Data are being analyzed using qualitative content analysis, which includes inductive code development and theme generation. Results: Thick description of the findings place participants' attitudes and behaviors in the context of their social and cultural milieu, as well as the body of research on food access. Conclusions: Perceptions of resources and barriers to food access have significant consequences in food consumption and, ultimately, health outcomes. Low-income families face significant challenges in eating healthfully. Understanding the complexities of food choices in this population can guide public health nurses' development of tailored interventions to address social determinants of diet-related diseases.