Qualitative Exploration of Cultural Influence on a Rural Health-Promotion Initiative.

OBJECTIVE: To develop a conceptualization of cultural influence on perceptions of a rural food and physical activity policy, systems, and environmental (PSE) change project to inform public health research and practice. DESIGN: Basic qualitative research design, semistructured phone interviews with community health coalition members. SETTING: Five rural Southern counties (obesity prevalence > 40%). PARTICIPANTS: Thirty-nine community coalition members. INTERVENTION: The Centers for Disease Control and Prevention High Obesity Program. PSE initiatives to increase access to healthy food and physical activity opportunities through a community coalition model. PHENOMENON OF INTEREST: Social norms and cultural influences surrounding community members' food preferences, physical activity behavior, and future hopes for community development. ANALYSIS: Abductive content analysis. RESULTS: Major categories on food social norms (subcategories: physical health, eating habits, and food preference), race relations, generational factors, physical activity social norms, and hopes for the community (subcategories: increased engagement, health, awareness, cohesion, and inspiration) were discussed in relation to the progress of PSE initiatives. CONCLUSIONS AND IMPLICATIONS: Because of community member perceptions, PSE initiatives became associated with factors beyond food and fitness, such as race relations, generational differences, and community cohesion. A focus on increased youth and church involvement, community values, relationship building, and input from diverse voices can be foundational to culturally-appropriate PSE efforts in rural settings.