From Health Sciences, Departments of Family Medicine and Neurosurgery, and the Department of Neurosurgery at the Rockefeller Neuroscience Institute, West Virginia University, Morgantown, and Pocahontas Memorial Hospital, Buckeye, West Virginia.
South Med J. 2022 Mar;115(3):214-219. doi: 10.14423/SMJ.0000000000001370.
West Virginia (WV) is the only state entirely located in Appalachia, a large, mostly rural area in the eastern United States. WV has the highest adult obesity rate in the United States, as well as one of the highest physical inactivity rates. Obesity has been found to be significantly higher in rural counties than in urban counties, and many rural communities do not have the resources to address this growing health concern. It is well documented that healthy eating and becoming more physically active can be successful in reducing weight and managing obesity-related illness. Despite this overwhelming evidence, obesity rates in WV continue to climb. The purpose of this study was to understand the factors associated with obesity in WV and identify what influences the behavior of people in regard to weight loss and exercise.
Four focus groups were conducted across the state of WV, transcribed, and thematically analyzed to examine the facilitators and barriers associated with healthy behaviors. The Consolidated Framework for Implementation Research (CFIR) was used as an approach to classify characteristics and plan implementation strategies integrating five domains. The CFIR has been used to identify potential barriers and facilitators to interventions and can be used before or during an intervention. In addition, the CFIR has been used as a framework to guide analysis and provide a means to organize intervention stakeholders' perceptions of barriers and facilitators to successful interventions.
Participants identified barriers and facilitators across all 5 major domains of the CFIR-intervention characteristics, outer setting (eg, cultural norms, infrastructure), inner setting (eg, access to knowledge), characteristics of individuals, and the implementation process-and 16 subdomains. Participants discussed how socioeconomic, cultural, and environmental factors influenced diet and exercise. Cost, family culture, and limited access to resources (eg, healthy foods, community-based fitness programs, health care) were common themes expressed by participants.
The results of this study identify how individuals living in rural Appalachian view lifestyle changes and what influences their ability to pursue physical activity and healthy eating. Future programs to encourage healthy lifestyles in Appalachia need to consider the characteristics of the given community to achieve the goal of a tailored lifestyle intervention program that is feasible and effective. In addition, the findings suggest that the CFIR can be used to implement and refine intervention strategies that can be used in the real world.
西弗吉尼亚州（WV）是唯一一个完全位于阿巴拉契亚地区的州，阿巴拉契亚是美国东部一个大型的以农村为主的地区。WV 的成年人肥胖率居全美之首，身体活动不足率也位居前列。肥胖在农村县比在城市县更为普遍，许多农村社区缺乏解决这一日益严重的健康问题的资源。有大量文献证明，健康饮食和增加身体活动可以成功减轻体重并控制肥胖相关疾病。尽管有压倒性的证据表明，WV 的肥胖率仍在继续攀升。本研究的目的是了解与 WV 肥胖相关的因素，并确定哪些因素影响人们减肥和锻炼的行为。
在 WV 全州范围内进行了 4 个焦点小组，对其进行转录并进行主题分析，以检查与健康行为相关的促进因素和障碍。采用实施研究综合框架（CFIR）作为一种方法，根据五个领域对特征进行分类，并制定整合策略。CFIR 已被用于确定干预措施的潜在障碍和促进因素，可在干预之前或期间使用。此外，CFIR 还被用作分析的框架，并提供一种组织干预利益相关者对成功干预的障碍和促进因素的看法的手段。
参与者确定了 CFIR 的所有 5 个主要领域（干预特征、外部环境（如文化规范、基础设施）、内部环境（如知识获取）、个体特征和实施过程）以及 16 个子领域的障碍和促进因素。参与者讨论了社会经济、文化和环境因素如何影响饮食和运动。参与者普遍表达了成本、家庭文化和获取资源的有限性（如健康食品、社区健身计划、医疗保健）等主题。
本研究的结果确定了生活在阿巴拉契亚农村的个人如何看待生活方式的改变，以及哪些因素影响他们追求身体活动和健康饮食的能力。未来鼓励阿巴拉契亚地区健康生活方式的计划需要考虑特定社区的特点，以实现量身定制的生活方式干预计划的目标，该计划具有可行性和有效性。此外，研究结果表明，CFIR 可用于实施和完善干预策略，这些策略可在现实世界中使用。
