Using a Social Ecological Model to Explore Upstream and Downstream Solutions to Rural Food Access for the Elderly

A social ecological model is applied to the secondary analysis of qualitative data to study the impact of place on rural food access for older adults in West Virginia. The use of a social-ecological model to review the senior’s coded narratives provided a clearer picture of higher impact, upstream levers to address food security for older adults in a rural region. The elderly have restricted access to food in rural West Virginia because of an indirect relationship with place that acts through the social ecological domains of the built environment, macrosocial factors, stressors, the natural environment, and social support. The results of this analysis add to theories on upstream policy sectors that may contribute to food security and the quality of dietary intake for older adults in rural places. As senior populations increase the need for greater understanding of the place-based causal pathways for rural food insecurity and poor nutrition in older adults will become more important for program and policy decisions

Co-constructing Food Access Issues: Older Adults in A Rural Food Environment in West Virginia Develop a Photonarrative

This photovoice study examined the hypothesis that photos and narratives produced by older adults would facilitate the co-construction of a shared narrative about the food access issues in a rural county in West Virginia. For older adults, living in rural areas, several factors decrease access to healthy, nutritious food relative to the general population of older adults. Methods: Qualitative data from interviews, written narratives, dialogues, and photos from older adults living in a rural county of West Virginia. Was collected. Using directed content analysis, transcripts of written data were broken down into meaningful quote segments. All written data and photos were thematically coded using the five dimensions of food access. Results: Community-based participatory research (CBPR) as photovoice brought researchers and older adults together in a deliberative dialogue about rural food access and health. Analysis confirmed that shared photos and narratives among the elderly participants helped to facilitate agreement around problems with rural food access. Difficulties with the accessibility of food exceeded problems with the availability of food where geography includes psychosocial and physiological elements and the willingness of vendors to accommodate problems with restricted mobility and incomes. Conclusions: Public health practitioners and the elderly should benefit from community-based participatory research (CBPR) where photovoice enables an external research team to open up a conversation where community members may explore and co-create an understanding of person-place dynamics, environmental strengths, complex conditions, and policies that influence the lives of the community

Appalachia: Putting the Critical in Race and Crowdsourcing a Pathway Model on Institutional Racism

As the website Understanding and Dismantling Racism: Crowdsourcing a Pathway Model in Appalachia explains, we are seeking assistance in refining a pathway model that elucidates institutional racism from the unique standpoint of Appalachia. We think that Appalachia has a distinctive cultural toolkit that shapes its orientation on issues. Our goal is to use crowdsourcing to harness this unique Appalachian ethos to refine the Pathway model on Institutional Racism based on comments, edits, questions, and ideas left on the website

West Virginia Food Desert Summit 2019 Final Report

West Virginia University (WVU) Davis College of Agriculture and School of Public Health, with assistance from the USDA Natural Resources Conservation Service (NRCS), have been working to identify the structural factors that create food deserts or serve as barriers to food security in West Virginia. This group has hosted a series of meetings since 2018 that have brought together key players and existing committed groups with a perspective on food deserts to 1) identify factors limiting access and opportunities to attain nutritious, affordable, and acceptable food, and 2) generate a prioritized list of strategies that actors in the state can consider to address its food security problems. A third convening on December 10, 2019 (“the Summit”) was held with the aim of developing a community-driven plan of action that builds on the assets and activities already underway in the region. The goals of this convening were to: Identify the interests of key stakeholder groups that play a role in addressing food deserts. Have groups understand and catalog the roles and programmatic activities of groups that could address part of a food desert plan. Develop proposals that merge the issues and perspectives of several sectors and can formulate a blueprint to address food deserts in West Virginia

Rural Health Inequities and the Role of Cooperative Extension

Health inequities affect communities through adverse health outcomes, lost productivity, and increased health care costs. They arise from unequal distribution of social determinants of health—the conditions in which people are born and live. Health outcomes, tied to behaviors and health care, also are rooted in location and social status. Cooperative Extension provides culturally appropriate programs that touch the places where individuals and families live. A history of promoting democracy through education makes Extension uniquely positioned to address health inequities and foster greater equality among groups that experience hardships as a result of differences in social, economic, and environmental determinants of health

Shifting the gaze of the physician from the body to the body in a place: A qualitative analysis of a community-based photovoice approach to teaching place-health concepts to medical students

Medical practitioners, trained to isolate health within and upon the body of the individual, are now challenged to negotiate research and population health theories that link health status to geographic location as evidence suggests a connection between place and health. This paper builds an integrated place-health model and structural competency analytical framework with nine domains and four levels of proficiency that is utilized to assess a community-based photovoice project’s ability to shift the practice of medicine by medical students from the surface of the body to the body within a place. Analysis of the medical student’s photovoice data demonstrated that the students achieved structural competency level 1 proficiency and came to understand how health might be connected to place represented by six of the nine domains of the structural competency framework. Results suggest that medical student’s engagement with place-health systemic, institutional and structural forces deepens when they co-create narratives of their lived experiences in a place with patients as community members during a community-based photovoice project. Given the importance of place-health theories to explain population health outcomes, a place-health model and structural competency analytical framework utilized during a community-based photovoice project could help medical students merge the image of patients as singular bodies into bodies set within a context

West Virginia’s Sugary Drink Tax: Examining Print Media Frames in Local News Sources

Introduction: Framing is an important aspect of the policy process that helps the public and decision makers sort through and resolve highly charged claims about an issue. Through slight changes in the presentation of issues, a framing effect may alter public support. The way a proposed sugary drink tax is discussed in public discourse and by the media significantly influences policy acceptance. Given the public health significance of obesity and diabetes in West Virginia (WV) the study of media frames employed to represent a sugary drink tax policy is useful. Methods: Using quantitative content analysis, this study assessed news articles—published over 7 years by news outlets in WV—to determine the frames that were employed. Results: Pro-tax arguments appeared more often in these articles. In both pro- and anti-tax arguments, a personal behavior or economic frame appeared more frequently. The more common anti-tax arguments focused on the tax being regressive and not changing personal behavior. The pro-tax arguments focused more often on increases in state revenues and people selecting healthier beverages. Implications: Given the significance of obesity and diabetes in WV, the study of media frames that represent the sugary drink tax should provide valuable guidance to inform strategies that utilize public discourse and media coverage to influence policy acceptance. However, since WV has not been able to get approval for its sugary drink tax, it may be beneficial to examine other elements of agenda setting including issue generation tactics, mobilizing structures, and political opportunities

Fitting a Square Peg Into a Round Hole: Perceptions of Appalachian Physicians on the Incorporation of Chronic Disease Prevention Into Their Practice

This study used a focus group in August 2017 (n = 9) to explore the perceptions of rural physicians to a state request to incorporate diabetes prevention screening into their West Virginia medical practice. Analysis of the data revealed that the participants did not think private physicians were equipped to incorporate diabetes prevention programming into their practice. Three categories emerged from the data analysis to explain the reasoning of the health practitioners on the incorporation of pre-diabetes screening and management into their practice. ⁎ The practice of medicine ⁎ Prevention is a mismatch ⁎ Social determinants of health In the end, the study revealed that a request for physicians to identify and refer at risk patients to a diabetes prevention program is problematic due to conceptual and structural issues. Based on the findings it does not appear at this time that private physicians in rural settings can incorporate diabetes prevention into their existing practice. To address conceptual and structural barriers the invitation to rural physicians must: 1) present evidence on how physicians may be effective in a diabetes management team; 2) include a model that demonstrates a limited, specific role and duties for the physician within a team setting; and last, 3) integrate physicians into an existing community-based network of social and human service providers set up to provide diabetes prevention services

The emergence of the social determinants of health on the policy agenda in Britain: A case study, 1980–2003

Numerous theories have been advanced in the effort to explain how a given policy issue manages to take root in the public sphere and subsequently move forward on the public legislative agenda—or not. This study examined how the social determinants of health (SDOH) came to be part of the legislative policy agenda in Britain from 1980 to 2003. The specific objectives of the research were: (1) to conduct a sociopolitical analysis grounded in alternative agenda-setting theories to identify the factors responsible for moving the social determinants health perspective onto the British policy agenda; and (2) to determine which of the theories and related dimensions best accounted for the emergence of this perspective. A triangulated content and context analysis of British news articles, historical accounts, and research commentaries of the SDOH movement was conducted guided by relevant agenda-setting theories set within a social movement framework to chronicle the emergence of the SDOH as a significant policy issue in Britain. The most influential social movement and agenda setting elements in the emergence of the SDOH in Britain were issue generation tactics, framing efforts, mobilizing structures, and political opportunities grounded in social movement and agenda setting theories. Policy content or the details of the policy had comparatively little impact on the successful emergence of the SDOH. Despite resistance by the government, from 1980 to 1996 interest groups created a political understanding of the SDOH utilizing a framing package encompassing notions of inequality, fairness, and justice. This frame transmitted a powerful idea connected to a core set of British values and beliefs. After 1996, a shift in political opportunities cemented the institutional arrangements needed to sustain an environment conducive to the development and implementation of SDOH policies and programs. This research demonstrates that the U.S. emergence of the SDOH on the policy agenda will depend upon: (1) U.S. ideals and values regarding poverty, inequality, race, health, and health care that will determine issue framing; (2) political opportunities that will emerge—or not—to advance the SDOH policy agenda; and (3) the mobilizing structures that support or oppose the issue