Spatial and Psychosocial Influences on Food Access in Rural Appalachia

Purpose: To assess detailed individual-level information about complex factors affecting access to healthy foods in a vulnerable rural Appalachian population. Methods: A cross-sectional, mixed-methods study was conducted in a rural Appalachian county in southwestern Virginia. Methods included location and identification of food retailers, food store surveys, and in-depth interviews with lower-income women who managed their household food. Results: Fifty stores were identified, of which 28 were surveyed. Nine women participated in interviews. Supermarkets had the best overall availability, price, and quality of healthy foods, but grocery stores were also favorable for healthy foods as well as good service. Participants described criteria for selecting stores and foods in stores, as well as personal, social, and community factors that affected their food choices. Conclusion: This research suggests that a combination of factors influences access to healthy foods in a rural Appalachian community, including potential availability of healthy foods in retail stores, and a multitude of factors in the lives of consumers. Community-level interventions to increase the ease of eating healthfully may include changes in food retail, consumer education, and promotion of traditional food culture including home food production.