29-06-2012, 11:38 AM
Assessment of The Nutrition and Physical Activity Education Needs of Low-Income, Rural Mothers: Can Technology Play a Role
Abstract
The purpose of this study was to examine the perceptions of low-income, rural mothers regarding their need for nutrition and physical activity education and the role of technology in addressing those needs. Quantitative and qualitative research was combined to examine the nature and scope of the issues faced by this target population. Women who were currently receiving food stamps and had children in nursery school to eighth grade were recruited through a state database to participate in a telephone survey (N = 146) and focus groups (N = 56). Low-income, rural mothers were aware of and practiced many health behaviors related to nutrition and physical activity, but they faced additional barriers due to their income level, rural place of residence, and having children. They reported controlling the fat content in the food they cooked and integrating fruits and vegetables but showed less interest in increasing fiber consumption. They reported knowing little about physical activity recommendations, and their reported activity patterns were likely inflated because of seeing housework and child care as exercise. To stretch their food budget, the majority reported practicing typical shopping and budgeting skills, and many reported skills particularly useful in rural areas: hunting, fishing, and canning. Over two-thirds of the survey respondents reported computer access and previous Internet use, and most of those not yet online intended to use the Internet in the future. Those working in rural communities need to consider technology as a way to reach traditionally underserved populations like low-income mothers.
Introduction
Two thirds of adults in the United States are either overweight or obese,[1] which places them at risk for premature death, heart disease, diabetes and other health problems as well as threatens their quality of life.[2] Obesity disproportionately affects women with lower incomes, racial and ethnic minorities, and rural populations.[3,4]
Limited resource and rural populations face particular challenges when attempting to be physically active and eat healthfully. Barriers include difficulty accessing healthy food products and physical activity venues due to cost or availability, cultural norms, and lack of transportation, time, and social support.[4-7] Family commitments have also been shown to be a barrier for women with children.[6] The physical environment in rural areas may also pose a challenge for residents seeking to engage in outdoor physical activity due to fewer sidewalks.[4]
The national health objectives in Healthy People 2010 identify several priority areas for improving community health related to overweight and obesity, including health promotion through interventions targeting weight and diet (Goal 19) and physical activity (Goal 22).[3] Goal 11 also recommends using "communication strategically to improve health," which includes the implementation of innovative and effective communication strategies and increasing the proportion of households with Internet access.[3,8,9] The national health objectives focus on Internet as a primary technology for consumer health education, but other technologies, such as cell phones, have become ubiquitous and could serve as key health education channels. For the purpose of this project, however, addressing Internet access and use was the focus.
Eight in ten Internet users have searched online for health information, with half (51%) seeking information on diet and nutrition and 42% seeking information on exercise or fitness.[10] Given the increased accessibility of health information on the Internet, closing the digital divide is imperative when addressing health disparities. Despite increasing rates of home Internet access, some population sub-groups do not go online, particularly older adults, African-Americans, those with low educational attainment or income, and rural populations.[10-12] In addition, much of the online health information does not meet the needs of low-literate audiences because health content is often written at an advanced reading level.[13] These barriers must be bridged in order to effectively communicate health information online to these populations.
Consistent with Healthy People 2010, the "Eat Smart, Be Fit, Maryland!" project was initiated to create a health promotion intervention tailored to limited resource populations in Maryland, while simultaneously exploring strategies to close the digital divide in rural, low income households. The project is a collaborative effort between the Maryland Cooperative Extension (MCE), the Public Health Informatics Research Laboratory at the University of Maryland, and other researchers at the University of Maryland, College Park. The MCE directs the Food Stamp Nutrition Education Program in Maryland, and a primary goal of the "Eat Smart, Be Fit, Maryland!" project is to enhance nutrition education for people eligible for food stamps.
According to 2005 statistics, the majority of households participating in the food stamp program (63%) were headed by a single adult, and most of these (95%) were headed by women.[14] Women account for 68% of all non-elderly adult food stamp participants.[14] Given food stamp participation levels and the role of women in selecting and preparing meals for children in single parent households, the target population for this project was adult female food stamp recipients with school age children.
The project began with an intensive needs assessment involving input from the target audience and community stakeholders and a review of community resources. This effort was an important step in determining the needs and strengths of the community and the relevance and acceptance of the project. It was also a necessary step that allowed us to build relationships and trust in the community. The purpose of this paper is to describe the qualitative and quantitative research methods conducted with the target population. A household telephone survey was conducted with the target population to collect information on attitudes and behaviors related to nutrition, physical activity, technology use, and information seeking. Focus groups with food stamp recipients and those eligible for food stamps were conducted to assess the needs and strengths of the target population in relation to nutrition, physical activity, and technology. Focus groups were also used to assess reactions to an Internet-based health promotion program in their community.
This paper provides detailed findings from these research activities, including the self-described health behaviors and technology use of the target population. While exploratory research on the nutrition and physical activity needs of low-income women has been conducted in the past, these studies have primarily concentrated on special populations, such as ethnic minorities,[5,15] women with chronic diseases or disabilities,[15-19] and older adults.[18-22] Several other studies have focused on women in younger age categories as well.[23,24] This study targeted adult female food stamp recipients with school age children living in rural communities. Research questions included:
What are the perceived needs of the target population regarding nutrition and physical activity education?
What are the technology use patterns of the target population?
How will the target population respond to an educational intervention administered using computers and the Internet?
Conclusions
The purpose of this research was to determine the acceptability of an Internet-based health education intervention with a population where this strategy is not typically used: low-income, rural mothers. This paper presented findings about this group's perceptions related to nutrition, physical activity and technology. Some of the findings were surprising, particularly how many were actually using the Internet or were interested in doing so. They expressed great care and concern about their families and providing healthy, economical meals to them. They were aware of and practiced a number of positive nutrition and physical behaviors. However, there is room for improvementbetter meal planning skills, increased knowledge related to fiber consumption, and making physical activity more of a priority in their busy lives. As a result of this study, future research should continue to explore how technology can be leveraged to reach this traditionally underserved population.