Measuring capability for healthy diet and physical activity.
OBJECTIVE
Patterns of diet and physical activity, major drivers of morbidity and mortality, are contingent on people's feasible opportunities to pursue healthy behaviors. Our objective for this mixed methods study was to develop measures of feasible opportunities for diet and activity.


METHODS
The Capability Approach framework for evaluating people's real freedoms to pursue their values guided the research. A community-based participatory model was applied to conduct focus groups of adults with obesity or diabetes mellitus from an economically disadvantaged Latino community. Focus group themes were developed into survey items that assess how individual circumstances and neighborhood contexts influence opportunities for diet and activity. The prevalence of different influences was explored in a sample of 300 patients from a primary care safety net clinic. Scales measuring different aspects of opportunity were created through principal components analysis.


RESULTS
Availability, convenience, safety, cost of food, and activity resources interact with individual circumstances, such as illness, depression, family and nonfamily supports, and scope of personal agency, to shape practical opportunities. Multiple vulnerabilities in availability of resources and moderators of resource use commonly occur together, intensifying challenges and creating difficult trade-offs. Only one-half of participants reported that physicians understood their difficulties pursuing activity, and just one-third for diet.


CONCLUSIONS
Our results suggest that practical opportunities for healthy behavior can be measured as a primary target for clinical and public health assessment and intervention. The Capability Approach holds promise as a framework for developing interventions responsive to both personal and environmental determinants.
Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
Robert L
RL
Ferrer
Inez
I
Cruz
Sandra
S
Burge
Bryan
B
Bayles
Martha I
MI
Castilla
D000293:Adolescent; D000328:Adult; D000368:Aged; D055812:Community-Based Participatory Research; D003920:Diabetes Mellitus / Q000628:therapy*; D004032:Diet; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D006295:Health Resources; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009765:Obesity / Q000628:therapy*; D011203:Poverty; D012931:Social Environment; D011795:Surveys and Questionnaires; D055815:Young Adult
health behaviors; models, theoretical; qualitative research; social environment