Using Mixed Methods to Identify Community Needs/Challenges, Assets, and Opportunities for Promoting Healthy Weight in Preschool-Aged Children in Two Rural Communities

OBJECTIVES: Child obesity is a serious public health concern in rural areas. Some multi-level child obesity prevention interventions have been conducted in the U.S., but none have targeted rural areas. This formative study assesses needs/challenges, assets, and opportunities to promote healthy weight in preschool-aged children in two rural communities that will guide the development of a multi-level community-based intervention. METHODS: Mixed methods were used in two rural communities in Indiana and North Carolina. Parents of children aged 2–5 years participated in focus groups (27 parents) or interviews (14 parents). Childcare providers (n = 13) and stakeholders from 23 community organizations participated in interviews. Observational audits of grocery stores and physical activity resources were conducted using CX3 and the Physical Activity Resource Assessment tools, respectively. RESULTS: Family barriers included limited nutrition knowledge, cooking skills, and financial resources. Childcare providers cited a disconnect between childcare and home practices, lack of funding and training in health, and limited childcare options to meet family demands. Community level challenges centered on lack of transportation, limited infrastructure in the built environment to support healthy lifestyles, and limited community activities/opportunities to be physically active. Reported community challenges were supported by audits- 38% of stores carried high-quality fruits/vegetables; 25% met recommended standards for other healthy foods, and the average physical activity environment score was 0.6 (out of 3). Assets included community organizations (food pantries, farmers markets, childcare) that provided access to low-cost healthy meals and avenues for families to connect/learn about healthy lifestyles. Participants recommended that interventions involve community partnerships, target the entire family, improve resource dissemination to the community, leverage existing resources, and explore avenues to improve existing infrastructure. CONCLUSIONS: Barriers to healthy weight exist in rural areas, but there are assets that can be leveraged. These findings will guide the development of a rural community-based child obesity prevention intervention. FUNDING SOURCES: NIH award (5R03HD097393) and UNC Chapel Hill.