Recent evidence highlights health disparities among rural communities. The purpose of this study was to learn from members of 2 Appalachia communities in North Carolina about barriers to health and well-being. Researchers conducted 3 focus groups (n = 24), which were coded and analyzed by a team of researchers to identify themes. Researchers identified 5 themes: (1) poverty/lack of economic opportunity; (2) access to health care and health resources; (3) social/mental health challenges; (4) food insecurity/hunger; and (5) youth/older adults being most vulnerable to health disparities. Ample evidence suggests that rural Appalachia is in dire need of public health attention.
The present study planned and implemented a new farmers' market (FM) at a WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) clinic in North Carolina, of which WIC FM Nutrition Program (FMNP) participants were the main priority population. The purpose of this FM was to provide convenience and improve access to locally grown fresh fruits and vegetables in the community and to increase the FMNP coupon redemption rate. The main objective of this study was to describe the overall process and key strategies involved in implementing a FM at a WIC clinic. A community-based participatory research design using different formative methods documented the process and key inputs in FM implementation. Local farmers, program administrators, and community advocates were involved in documenting the implementation process. Multiple formative methods included direct observation and semistructured interviews with staff and farmers (n = 13). A community partnership was key in implementing the FM. The market operated weekly over the course of 24 weeks, involved 12 WIC-approved farmers, and featured over 50 types of fresh fruits and vegetables. The FMNP coupon redemption rate at the county level increased from 51.3% to 62.9%. The results demonstrate that a FM can be successfully located near a WIC clinic with positive effects of increasing availability to fresh fruits and vegetables for a low-income population and revenue for local farmers.
Outcomes Measures and Analysis: Construct validity was evaluated by Spearman correlation between total scores on the SAHL-S and the NLit-S. Reliability was measured by Cronbach's alpha. Results: Most participants were female (76%), with a mean age of 35 years (range 18-63, SD: 12.85). Mexico was the most prevalent country of origin (74.5%). Approximately half of the participants (51%) had an annual income lower than 20,000 dollars. The primary language of the participants was Spanish, where 74.5% reported to speak only Spanish or more Spanish than English at home. NLit-S construct validity was significant (r¼ .51, p< .01), and reliability was excellent (a¼ .92). Conclusions and Implications: The NLit-S is a potential tool for measuring the nutrition literacy of spanish speaking populations, though testing in a larger sample is needed.
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