Learning the Lay of the Land: Needs Assessment for a Community Environmental Approach to Obesity Prevention
Over 60% of adult Americans are now considered overweight or obese. This is of special concern to women because post-menopausal obesity may increase the relative risk of developing breast cancer by as much as 40%. Until recently, efforts to address the problem of obesity have centered on technical rational education and individual behavior change models. However, population-level solutions are necessary to address public health problems such as obesity. A population-level approach requires attention to both physical and social contexts within the community. In order to better understand the contexts from within which individuals make health behavior decisions, this study asks: How do community members perceive the role of the social and physical environment on overweight and obesity, and on their own eating and physical activity behavior? The thesis is that those social and physical environmental factors do influence the perceptions of community members. A qualitative, constructivist approach in partnership with members of the community of focus was used in an attempt to answer the research question. The study objectives were 1) increased understanding of community members? perceptions of the way the physical and social environment for healthful eating and active living affect their decisions about eating and exercise, and 2) development and testing of methods for conducting a community environmental assessment. The assessment was conducted over an eight-month period in a rural New York town where over 60% of the adults were overweight or obese. Using a participatory, collaborative approach with Cooperative Extension partners and a local cancer coalition, the assessment included a study sample of 25 adults identified through purposeful and snowball sampling. Methods included 17 individual interviews, two focus group discussions, community observation, and photo elicitation. The assessment process revealed a profile specific to a unique population and context. Data were revealed that illustrate the role perceptions of environmental influences play in eating and exercise decisions in the context of a local community. Constructs from both theory and public health practice contributed to study methods that facilitated a deeper understanding of community members? perceptions of local context and provided an important lens through which to view the health environment in the community. The study revealed data that illustrate three key themes. First, ownership of obesity is seen as both an individual and a collective problem. Second, there are conflicting goals for food and physical activity in the community. Third, there is a relationship between the social and physical environment that has not been addressed in existing models. These three key findings add an important dimension to the understanding of context within which individuals make eating and exercise decisions. These results suggest that a community environmental assessment can be a useful strategy for understanding how the physical and social environments can affect health behavior. Learning the lay of the land requires a contextual view from both the physical and social perspectives of community residents. This study demonstrates that these perceptions can be captured and provides an important foundation for exploring locally tailored, community-based approaches to obesity prevention. More research is needed to provide both theoretical refinement and testing of this methodological approach to improve community nutrition practice and policy.
obesity; environment; breast cancer; needs assessment; context; perceptions; education; community; Cooperative Extension
dissertation or thesis