title: Retail Food Store Access in Rural Appalachia: A Mixed Methods Study.
abstract: To describe how characteristics of food retail stores (potential access) and other factors influence self-reported food shopping behavior (realized food access) among low-income, rural Central Appalachian women.
  
  
  
  Cross-sectional descriptive. Potential access was assessed through store mapping and in-store food audits. Factors influencing consumers' realized access were assessed through in-depth interviews. Results were merged using a convergent parallel mixed methods approach. Food stores (n = 50) and adult women (n = 9) in a rural Central Appalachian county.
  
  
  
  Potential and realized food access were described across five dimensions: availability, accessibility, affordability, acceptability, and accommodation. Supermarkets had better availability of healthful foods, followed by grocery stores, dollar stores, and convenience stores. On average, participants lived within 10 miles of 3.9 supermarkets or grocery stores, and traveled 7.5 miles for major food shopping. Participants generally shopped at the closest store that met their expectations for food availability, price, service, and atmosphere. Participants' perceptions of stores diverged from each other and from in-store audit findings.
  
  
  
  Findings from this study can help public health nurses engage with communities to make affordable, healthy foods more accessible. Recommendations are made for educating low-income consumers and partnering with food stores.
authors.affiliation: School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.|School of Nursing, University of Virginia, Charlottesville, Virginia.
authors.forename: Esther
authors.initials: E
authors.lastname: Thatcher
authors.affiliation: Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Cassandra
authors.initials: C
authors.lastname: Johnson
authors.affiliation: College of Nursing, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Zenk
authors.affiliation: School of Nursing, University of Virginia, Charlottesville, Virginia.
authors.forename: Pamela
authors.initials: P
authors.lastname: Kulbok
mesh_terms: D000328:Adult; D001061:Appalachian Region; D003132:Commerce / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D005502:Food / Q000191:economics / Q000706:statistics & numerical data; D005523:Food Supply / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D011203:Poverty; D012424:Rural Population / Q000706:statistics & numerical data
keywords: Virginia; commerce; food supply; geographic information systems; medically underserved area; rural population