Perceptions of the Environment

for Eating and Exercise in a Rural

Community
Presented by:
Ryan Bradshaw
Oladipo Eddo

Maley, M., Warren, B. S., & Devine, C. M. (2010). Perceptions of the environment for eating and exercise in a rural
community. Journal of nutrition education and behavior, 42(3), 185-191.

Introduction
Obesity in the United States of America has increased at an
exponential rate over the last 20 years
Obesity is associated
Increased BMI
Increased risk of breast cancer
Increase in general cancer deaths
Energy imbalance

Background
Energy imbalance is influenced by

Individual factors
Social factors
Environmental factors
Societal factors

Environments that do not reinforce healthy habits have been

suggested to contribute greatly to the obesity epidemic.
Environmental approaches require a deep understanding of
perceptions of community members about these environmental
conditions and their relationship to eating and physical activity
behavior.

Purpose
The purpose of this ethnographic study was to assess
community members perceptions of social, built, and
natural environments and the effects of these
environments on their own eating and physical activity
behavior as a basis for designing environmental
interventions.

Methods
Study setting:
Rural community in Upstate New York
Population is about 1900
Median household income of $34,148
More than 60% of population were overweight or obese

The community was chosen due its limited resources

and availability of local leaders willing to participate in
the study.

Methods
Local leaders:
County cooperative extension association
Grass root cancer survivors coalition
Community members interested in health & cancer prevention

Between 27 and 30 members of the community

participated in this study
17 were recruited using purposeful and snowball
sampling

Methods
Purposeful sampling: Researcher purposefully chose
the individuals who will participate in the study for a
specific reason
Snowball sampling: Researcher begins with one or a
few subjects who are information-rich. Researcher asks
these subjects to recommend other people who could
offer confirming or contrasting views.

Ravitch, S. M., & Carl, N. E. (2016). Qualitative Research: Bridging the Conceptual, Theoretical, and
Methodological. Thousand Oaks, CA: Sage Publications, Inc.

Methods
10 additional participants were identified who participated
in the focus group
2 participants were involved both in the interview and focus
group
Recruiting participants:
Began with a researcher developed list of stakeholders to be included
Cooperative extension partner helped identify 17 individuals from
each category
Focus were on women due to the interest on breast cancer risk
reduction

Methods
Adults (over the age of 18)
Lived in the community for greater than 5 years
The list of stakeholders to be included was diverse and
exhaustive
During the process, authors asked themselves:
Who isnt represented? (Purposeful)
Whom else in the community should we be talking to? (Snowball)
This approached was utilized until no further names were
suggested for interviews.

Methods: Participants
Demographics:

20 to 80 years
3 white male and 2 African American women
The remaining participants were white, non-Hispanic women.
Community residence ranged from 7 to 50 years

Research study took place over an 8 month period

Research process was iterative and formative
Research team used reflexive experience to guide future steps
Community members provided insight to identify potential
environmental solutions
A consultant and collaborative research relationship

Theoretical model

Schulz, A., & Northridge, M. E. (2004). Social determinants of health: implications for environmental health promotion.
Health Education & Behavior, 31(4), 455-471.

A Constructivist Approach
Researchers evaluated the:
Local built environments
Natural environments
Social eating environments
Exercise environments

Data acquisition
Individual interviews - 17
Hour long audiotaped
Open-ended interview guide
Conducted by one trained interviewer

Data acquisition
Focus groups - 2
Themes generated from interviews were explored further
Conducted using Krugers methods
12 people participated in the focus groups
Participants were divided into 2 groups
Environmental factors related to active living
Environmental factors related to food choice

Use of mapping activity to set the mindset of the group

30 minutes in length, also served as a form of member checking

Data acquisition
Photo elicitation
Use of Photovoice to ensure validity by ensuring community members
perspectives are being captured
Photovoice: belief that what experts think is important may not match with what
individuals in the community think is important

11 members of the community leadership coalition were provided

disposable cameras
At the next project leadership coalition session, participants were told to
pick a picture or 2 and described how it illustrated the
Local built environments
Natural environments
Social eating environments
Exercise environments

Data analysis
Transcription were done in verbatim by 3 researchers
Data were coded to identify patterns related to study
themes
Development of categories for coding process included 3
procedural elements
Nomination of relevant text based on study objective, a priori
and emergent themes
Organization of data by the themes stated above
Independent verification by team members via peer debriefing
(to include credibility)

Validation
Constant comparative method allowed researchers to
analyze different perspective on central issues
Member checking was conducted during consultation
with extension partners in community
Triangulation, to increase dependability and validity,
was conducted in the form of
Data source
Method
Data type

Results/Discussion
Findings from the current study demonstrate that the
perceptions of social relationship to the availability of
and condition of facilities for food and physical activity
are an important influence on health behavior
The physical presence of built, natural and the social
environment of the community both present opportunities
and barriers for healthy living and physical activity,
however it is the participants perception that influences
their choices

Results/Discussion
The key findings from the study were:
Ownership of obesity was seen as both an individual and
collective problem
Participants described ways that their desired eating and
physical behaviors were in conflict with community values and
environmental conditions
There was a relationship between the social, built, and natural
environment that has not been addressed in existing models

Implications for research and

practice
Future community centered approach to combating
obesity as opposed to individual centered.
The need to better understand the features of the
environment, as well as community members
relationships with that environment.
Effective interventions must include identification of,
and support for, changes in factors that contribute to an
obesogenic environment.

Class Activities
Take a few minutes to map or list places
where
Food is eaten outside of your home
Where the food comes from in each instance
OR

Take a few minutes to map or list places

where
Physical activity takes place and what types of
physical activity occurs in these places

Class Activities
Photovoice
Depending on what subject you just chose
Take up to 5 minutes to walk around this building
and take a photo of something that is relevant to
the subject you just chose
Email the photo to

rbradsh5@gmu.edu

Class Activities
Photovoice
Depending on what subject you just chose
Questions that guided discussion included
What sort of things did you notice while you were doing
this?
What did you like about the photos you chose?
What do they represent?
What parts of the environment are not represented in these
photos?
Of all the photos which do you believe are most important?

THANK YOU