Barriers to Creating Healthier Home Food Environments: Process Evaluation Results From 2 Home Food Environment Intervention Studies.

Few studies have identified barriers to creating a home environment more supportive of healthy eating. We examined barriers faced by participants in a randomized controlled trial and an adaptation study of the Healthy Homes/Healthy Families intervention, which uses health coaches to support low-income families in creating healthier home food environments. Coaches maintained logs of participant interactions as part of a process evaluation. We thematically analyzed logs from interactions with participants, mostly lower-income African American women (n = 114), to identify barriers for each of 8 healthy actions that serve as core elements of the intervention. Difficulty of changing current habits was a barrier for 5 of the healthy actions. No time/convenience and limited family support each influenced 2 of the healthy actions, with interpersonal barriers also stemming from social situations and visitors, including grandchildren. Cost and economic challenges were barriers for 3 of the actions. Hunger, cravings, and limited access to resources (eg, transportation, fresh fruits and vegetables) were each noted as barriers for 1 healthy action. Overall, these findings provide insight for how to better support families who are trying to improve their home food environments and highlight the need for multilevel interventions.

Impact of Improving Home Environments on Energy Intake and Physical Activity: A Randomized Controlled Trial.

OBJECTIVES: We assessed the effectiveness of an intervention targeting home food and activity environments to reduce energy intake and increase physical activity among overweight and obese patients from 3 community health centers in rural Georgia. METHODS: We conducted a randomized controlled trial (n = 349) from 2011 to 2013, with follow-up at 6 and 12 months. Health coaches delivered the 16-week intervention by using tailored home environment profiles showing areas in need of improvement and positive aspects of the home environment, behavioral contracts for healthy actions, and mailed support materials. RESULTS: Participants were mostly African American women (84.8%), with a mean age of 50.2 years and a mean body mass index (weight in kilograms divided by the square of height in meters) of 38.3. Daily energy intake decreased more for the intervention than control group at 6 (-274 vs -69 kcal) and 12 months (-195 vs -76 kcal). We observed no change for either objective or self-reported physical activity. At 12 months, 82.6% of intervention participants had not gained weight compared with 71.4% of control participants. CONCLUSIONS: The intervention was effective in changing home environments and reducing energy intake.

Social Environmental Correlates of Health Behaviors in a Faith-Based Policy and Environmental Change Intervention.

Diet and physical activity are behavioral risk factors for many chronic diseases, which are among the most common health conditions in the United States. Yet most Americans fall short of meeting established dietary and physical activity guidelines. Faith-based organizations as settings for health promotion interventions can affect members at multiple levels of the social ecological model. The present study investigated whether change in the church social environment was associated with healthier behavior at church and in general at 1-year follow-up. Six churches received mini-grants and technical assistance for 1 year to support policy and environmental changes for healthy eating (HE) and physical activity (PA). Socioenvironmental (social support and social norms) and behavioral (HE and PA at church and in general) outcomes were derived from baseline and 1-year follow-up church member surveys ( n = 258). Three of six churches demonstrated significant improvements in all three socioenvironmental aspects of HE. Two of five churches exhibited significant socioenvironmental improvements for PA at follow-up. Church social environmental changes were related to health behaviors at church and in general ( p < .05). Change in social support for HE, social support for PA, and social norms for PA were each associated with three church-based and general behavioral outcomes. Social norms for healthy eating were related to two general behavior outcomes and social norms for unhealthy eating to one general behavioral outcome. Study findings demonstrate that socioenvironmental characteristics are essential to multilevel interventions and merit consideration in designing policy and environmental change interventions.