There's Not a Magic Wand': How Rural Community Health Leaders Perceive Issues Related to Access to Healthy Foods and Physical Activity Across the Ecological Spectrum

Research on successful strategies to promote access to healthy foods and places to be active in rural U.S. counties is lacking. This study investigated the perceptions of 37 key informants (K.I.$) from four rural-State-counties about the barriers and assets related to promoting healthy eating and physical activity. Transcripts from interviews with K.I.'s were analyzed and coded according to the categories of the ecological model to better understand how K.I.s addressed health issues from individual to systemic levels. Rural community leaders were aware of the complex challenges their communities faced in promoting healthy eating and physical activity. However, despite identifying and attempting to address the structural barriers that inhibited the adoption of healthy lifestyles, many K.I.s lamented individuals' resistance to changes and-in some cases-blamed them for the poor health outcomes in their communities. While many of the K.I.s in this study were attuned to structural inequalities, they did not always know how to address these issues and, in some cases, faced push-back from their communities for addressing equity, racism, or discrimination. Given these findings, we recommend that rural health programs increase their capacity-building efforts in order to enhance the ability of rural county leaders to foster change within their communities across all levels of the ecological model. Additionally, this research demonstrates that health interventions in rural communities must be attentive to the ways that class and race impact health outcomes and shape how people are able to access services.