title: Understanding and addressing barriers to implementation of environmental and policy interventions to support physical activity and healthy eating in rural communities.
abstract: OBJECTIVE
  Rural residents are at greater risk of obesity than urban and suburban residents. Failure to meet physical activity and healthy eating recommendations play a role. Emerging evidence shows the effectiveness of environmental and policy interventions to promote physical activity and healthy eating. Yet most of the evidence comes from urban and suburban communities. The objectives of this study were to (1) identify types of environmental and policy interventions being implemented in rural communities to promote physical activity or healthy eating, (2) identify barriers to the implementation of environmental or policy interventions, and (3) identify strategies rural communities have employed to overcome these barriers.
  
  
  METHODS
  Key informant interviews with public health professionals working in rural areas in the United States were conducted in 2010. A purposive sample included 15 practitioners engaged in planning, implementing, or evaluating environmental or policy interventions to promote physical activity or healthy eating.
  
  
  RESULTS
  Our findings reveal that barriers in rural communities include cultural differences, population size, limited human capital, and difficulty demonstrating the connection between social and economic policy and health outcomes. Key informants identified a number of strategies to overcome these barriers such as developing broad-based partnerships and building on the existing infrastructure.
  
  
  CONCLUSIONS
  Recent evidence suggests that environmental and policy interventions have potential to promote physical activity and healthy eating at the population level. To realize positive outcomes, it is important to provide opportunities to implement these types of interventions and document their effectiveness in rural communities.
authors.affiliation: Prevention Research Center in St. Louis, School of Public Health, Saint Louis University, St. Louis, MO 63104, USA. barnidge@slu.edu
authors.forename: Ellen K
authors.initials: EK
authors.lastname: Barnidge
authors.forename: Catherine
authors.initials: C
authors.lastname: Radvanyi
authors.forename: Kathleen
authors.initials: K
authors.lastname: Duggan
authors.forename: Freda
authors.initials: F
authors.lastname: Motton
authors.forename: Imogene
authors.initials: I
authors.lastname: Wiggs
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Baker
authors.forename: Ross C
authors.initials: RC
authors.lastname: Brownson
mesh_terms: D004777:Environment; D015444:Exercise; D005247:Feeding Behavior; D006282:Health Personnel; D006284:Health Plan Implementation / Q000458:organization & administration*; D006291:Health Policy; D006293:Health Promotion / Q000379:methods; D006801:Humans; D012424:Rural Population; D014481:United States