An Examination of Intrapersonal and Environmental Factors Related to Use of Nutrition and Physical Activity Community Resources Among Underserved Women
Health promotion interventions among the underserved should address communitylevel barriers to healthy behaviors, as it is likely that such barriers exacerbate health disparities. This study employed qualitative and quantitative research methodology to examine intrapersonal and environmental factors related to use of nutrition and physical activity community resources among underserved women. Qualitative interviews were conducted to develop a conceptual framework describing influences on food choice in specific food environments. Key environmental influences on food choice were: (1) urban and rural differences in access to community food sources; and (2) the importance of the community nutrition environment surrounding work. At the intrapersonal level, food choices were influenced by women's desires to (1) provide healthy food for children and (2) prevent or manage disease. These data were also used to develop theory-informed community resource intervention tools, designed to enhance the ability of women to identify and address community barriers and resources. The newly developed community resource intervention tools were used in a randomized intervention trial of a cardiovascular disease risk reduction program for underinsured, midlife women (n = 236). In order to evaluate the impact of the community resource intervention tools, mediation analyses were conducted. In urban women, there was a iii significant intervention effect on self-reported use of nutrition resources. The effect on selfreported use of physical activity resources approached statistical significance. Self-efficacy for accessing resources was not a mediator, while knowledge was a potential mediator of the intervention effect on use of physical activity resources. To further examine the relationship between intrapersonal and environmental factors, the correlation between perceived and objectively measured access to physical activity resources was examined, revealing slight to moderate correlations. Cross-sectional analyses between objectively measured moderate to vigorous physical activity and perceived and objectively measured access to physical activity resources showed statistically significant associations between activity and (a) perceived distance to gyms, and (b) objectively measured number of schools in a 1-mile radius of participants' homes. Taken together, this research supports the importance of addressing both intrapersonal and environmental factors related to the use of community resources when designing future interventions
