The Privilege of Healthy Eating: A Qualitative Study Exploring the Local Food Choices of
Low-Income Families from Appalachia
Journal of Health Disparities Research and Practice Journal of Health Disparities Research and Practice
Volume 11 Issue 3 Article 10
© Center for Health Disparities Research, School of Public Health, University of Nevada, Las Vegas
2018
The Privilege of Healthy Eating: A Qualitative Study Exploring the The Privilege of Healthy Eating: A Qualitative Study Exploring the
Local Food Choices of Low-Income Families from Appalachia Local Food Choices of Low-Income Families from Appalachia
Iryna Sharaievska Dr.
, Appalachian State University
Stephanie West Dr.
, Appalachian State University
Melissa Weddell Dr.
, Appalachian State University
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Recommended Citation Recommended Citation
Sharaievska, Iryna Dr.; West, Stephanie Dr.; and Weddell, Melissa Dr. (2018) "The Privilege of Healthy
Eating: A Qualitative Study Exploring the Local Food Choices of Low-Income Families from Appalachia,"
Journal of Health Disparities Research and Practice
: Vol. 11: Iss. 3, Article 10.
Available at: https://digitalscholarship.unlv.edu/jhdrp/vol11/iss3/10
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The Privilege of Healthy Eating: A Qualitative Study Exploring the Local Food The Privilege of Healthy Eating: A Qualitative Study Exploring the Local Food
Choices of Low-Income Families from Appalachia Choices of Low-Income Families from Appalachia
Abstract Abstract
Using qualitative semi-structured interviews, 15 low-income women of different ages were asked to
discuss their perceptions of healthy eating, local farmers’ markets, as well as their visitation of farmers’
markets. The participants were also asked to share what features of farmers’ markets they found
appealing. The results showed that most of the participants had either a deep or moderate understanding
of what it means to eat healthy. However, many of them also believed they could improve their own
patterns of eating. The data also showed that the low-income women who took part in the study had
positive attitudes overall toward local farmers’ markets, despite rather low levels of visitation (only 5
participants had visited farmers’ market at least once and only one of them visited farmers’ market on a
regular basis). Lastly, participants discussed constraints that prevented them from visiting farmers’
markets more often and provided suggestions for possible facilitators to increase the frequency of their
use of farmers’ markets.
Keywords Keywords
Privilege; healthy eating; low-income families; Appalachia; local food
Cover Page Footnote Cover Page Footnote
Acknowledgments: Assistance for participants’ recruitment was provided by local District Health
Department. Financial Support: Financial support was provided by the Department of Recreation
Management and Physical Education, Appalachian State University.
This article is available in Journal of Health Disparities Research and Practice: https://digitalscholarship.unlv.edu/
jhdrp/vol11/iss3/10
137 Privilege of Healthy Eating: A Qualitative Study Exploring the Local Food Choices of
Low-Income Families from Appalachia
Sharaivska et al.
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Journal of Health Disparities Research and Practice
Volume 11, Issue 3, Fall 2018, pp. 137-148
© 2011 Center for Health Disparities Research
School of Community Health Sciences
University of Nevada, Las Vegas
The Privilege of Healthy Eating: A Qualitative Study Exploring the
Local Food Choices of Low-Income Families from Appalachia
Iryna Sharaievska, Appalachian State University
Stephanie West, Appalachian State University
Melissa Weddell Appalachian State University
Corresponding Author: Iryna Sharaievska, Appalachian State University,
ABSTRACT
Using qualitative semi-structured interviews, 15 low-income women of different
ages were asked to discuss their perceptions of healthy eating, local farmers’ markets, as
well as their visitation of farmers’ markets. The participants were also asked to share what
features of farmers’ markets they found appealing. The results showed that most of the
participants had either a deep or moderate understanding of what it means to eat healthy.
However, many of them also believed they could improve their own patterns of eating. The
data also showed that the low-income women who took part in the study had positive
attitudes overall toward local farmers’ markets, despite rather low levels of visitation (only
5 participants had visited farmers’ market at least once and only one of them visited
farmers’ market on a regular basis). Lastly, participants discussed constraints that
prevented them from visiting farmers’ markets more often and provided suggestions for
possible facilitators to increase the frequency of their use of farmers’ markets.
Key words: healthy eating, farmers’ market, low-income families, Appalachia
INTRODUCTION
Healthy eating is one of two factors (along with active lifestyle) that influence one’s ability
to maintain healthy weight and decrease the probability of obesity-related illnesses. According to
the Dietary Guidelines for Americans 2015-2020 (CDC, 2016), healthy eating “emphasizes fruits,
vegetables, whole grains, and fat-free or low-fat milk and milk products; includes lean meats,
poultry, fish, beans, eggs, and nuts; is low in saturated fats, trans fats, cholesterol, salt (sodium),
and added sugars; and stays within your calorie needs” (CDC, 2016). In order to achieve healthy
138 Privilege of Healthy Eating: A Qualitative Study Exploring the Local Food Choices of
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eating, CDC recommends to develop a balanced diet plan, substitute high-calorie for lower-calorie
ingredients while cooking, and replace unhealthy eating habits for healthier ones (CDC, 2016).
In an effort to combat the obesity epidemic and decrease obesity-related illnesses among
population of the United States, an abundant research and numerous social programs have focused
on the promotion of healthy eating (Ahluwalia et al., 2015; King, Mainous III, Carnemolla, &
Everett, 2009). However, considering the complexity of the issue and multiple factors influencing
healthy eating, it remains a privilege of a few, with college-educated higher socioeconomic status
women across most of the racial and ethnic groups being among those who eat the healthiest (CDC,
2015). Considering that among men no significant relationships has been found between education
level, SES and obesity prevalence (CDC, 2015), this study will focus on females only.
Among the groups of population who typically have less access to healthy food and
struggle with obesity and obesity related illnesses at a higher level are low income rural residents.
Rural Americans are at higher risk of death from five leading causes (heart disease, cancer,
unintentional injuries, chronic lower respiratory disease, and stroke) than their urban counterparts
(CDC, 2017). Such higher risk is associated with multiple social, economic and environmental
factors, including limited access to preventative healthcare, lack of education, lower access to
physical activity and healthy eating opportunities (CDC, 2017). One of the main recommendations
for improving health in rural communities provided by CDC was encouragement of physical
activities and healthy eating. Unfortunately, previous studies showed that rural adults were less
likely than non-rural residents to meet the Dietary Guidelines for Americans (Lutfiyya, Chang, &
Lipsky, 2012; Pullen & Walker, 2002). For example, the study by Pullen and Walker (2002)
revealed that only 5.9% of surveyed older women in rural communities adhered to all levels of the
Food Pyramid. Along with rural location, one’s socio-economic status is another factor predicting
one’s access to healthy eating, along with one’s “social support and modelling, availability and
accessibility of healthy and less healthy foods” (Burg, 2008, p. 50).
Among some of the techniques that were found to be effective in behavioral change when
it comes to healthy eating were self-monitoring and meal replacements and/or structured meal
plans, along with goal setting, problem solving, and social support (Spahn et al., 2010). Financial
reward strategies were found to be ineffective as a strategy to change one’s eating behavior (Spahn
et al., 2010). Other studies showed that family, structured support, translation of knowledge into
behavior modifications, barriers to physical activity, and religion are among other influential
factors changing eating behavior (Barnett & Praetorius, 2015). Thus, multiple factors, including
intrapersonal, interpersonal and environmental, need to be addressed to ensure a change in eating
behaviors.
One environmental factor prevalent in many rural and inner-city communities in the United
States has been defined by the USDA as Food Deserts, or “parts of the country that are
impoverished and lack access to fresh fruit and vegetable, and other healthful foods due to limited
access to grocery stores, farmers’ markets, and healthy food providers”. While there are multiple
communities in the Appalachian region that could be defined as food deserts, the community where
this research was conducted has a strong sustainable local food system, with delivery to local
residents through farmers’ markets, food stands, and community supported agriculture. In fact,
only 3.3% of total households did not have access to vehicles and were more than one-half mile
from a supermarket (USDA, 2017). Despite such a well-developed food system in the community,
the results of a study by Farmer, Chancellor, Robinson, West and Weddell (2014) indicated that
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the use of farmers’ markets and local food systems may vary among people of different background
(gender, education, income, and social connectedness). The authors also suggested that “various
segments of population may not be driven by the same value motivations (and levels)” (p. 322) to
use farmers’ markets. As a subsequent step following previous quantitative research, there is a
need to solicit more detailed feedback from low-income shoppers using food assistance programs
in order to gain a better understanding of their attitudes toward healthy eating, as well as local food
system.
Farmers’ markets as a part of the local food system, often bring multiple benefits to the
communities and thus, will be a primary focus of this study. According to the USDA’s National
Directory of Farmers Markets, the number of farmers’ markets in the U.S. increased from 1,755 to
8,144 between 1994 and 2013. While increase in the number of farmers markets alone does not
indicate healthier eating among the population, increased access to farmers’ markets was found to
be associated with healthier communities. For example, according to the Famers Market Coalition,
proximity to farmers markets was associated with lower body mass index (BMI) among North
Carolina youth. Moreover, those who visited farmers markets expressed preference for organic
food and food free from genetic modification (La Trobe, 2001). In a study by Kunkel, Luccia and
Moore (2003) when low income older adults were offered an opportunity to use vouchers at
farmers markets, 44% of them used this chance, with overwhelming majority of them reporting
the intention to eat fruit and vegetables year-round as a result of this program. In another study by
Ferdinand, Torres, Scott, Saeed, and Scribner (2017), African-American women with children
participated in the Fresh Market program incentivizing fruit and vegetable purchase. As a result
of the program, participants reported purchasing more fresh produce and increasing consumption
of fresh fruits and vegetables. In another study, the introduction of a farmers’ market into a
community with limited access to grocery shopping led to a decrease in price and an increase in
the availability of healthy foods (Larsen & Gilliland, 2009).
In addition to serving as a space that promotes healthy eating, farmers’ markets often
become more than a place to purchase local food, also serving as a recreational space and
community hub where visitors develop strong sense of sentimental place attachment (Johnson,
2013). Social interaction and the ability to meet the farmers involved in food production were
named by previous studies among reasons to attend farmers’ markets (Johnson, 2014; Szmigin,
Maddock, & Carrigan, 2003). Moreover, farmers’ markets are often located in public places, such
as parking lots and streets, public parks and churches, and community spaces (Ostrom & Donovan,
2013), and as a result, may contribute to the development of a sense of community. These spaces
may be even more important in rural spaces where both access to healthy food and recreation
opportunities are often limited (USDA Food Desert Locator, 2015).
This project explores the attitudes held by low-income families in a rural community of the
Appalachian Region about healthy eating, local foods and farmers’ markets. According to the
economic overview of Appalachia, the area consists of great contrasts and “still does not enjoy the
same economic vitality and living conditions as the rest of the nation” (U.S. Census, 2011). In
2009, per capita personal income in this area was 18% lower than the national level; and the rates
of cancer, heart disease, and diabetes were higher than the national rate (U.S. Census). Considering
that almost 30% of the population in the Appalachian region is obese (CDC, 2010), the issue of
healthy eating should not be underestimated.
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This study aims to explore: a) perceptions of low-income families in rural Appalachia about
healthy eating and local farmers’ markets, as well as their visitation of farmers’ markets; and b)
what factors could facilitate visitation of farmers markets by low-income families in rural
Appalachia on a more frequent or regular basis. Results of this study provide data that can help
guide community health practitioners and managers associated with sustainable local food
distribution systems as they make decisions that impact low-income residents.
METHODS
The principles of social constructionism and interpretivism, in which, “truth is not absolute
but is decided by human judgment” (Bernard, 2000, p. 18), were employed as the base
methodologies for this study (Crotty, 1998). As a result, experience that could be meaningful for
an individual or group of certain background (culture, income level, education, etc.) might be
completely irrelevant for an individual or group of different background.
The project took place during the spring of 2014 in a small rural town in the Appalachian
mountains. Participants were recruited with assistance from the local District Health Department
by using a purposive sampling technique with specific focus on low-income mothers (Bernard,
2000). Semi-structured individual interviews were conducted with low-income residents of the
area who were using WIC (Women, Infants, and Children) benefits and agreed to participate in the
study. Participants were compensated for their time with a $25 gift card. “The Special
Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides Federal grants
to States for supplemental foods, health care referrals, and nutrition education for low-income
pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up
to age five who are found to be at nutritional risk” (USDA, 2014). Participants of this study
consisted of fifteen low-income women of various ages (19-45) who had families of diverse
structures, including single-parent, cohabitating partners and married couples with one to three
children.
Interviews lasted for 20-30 minutes and were conducted in a vacant office of the local
District Health Department. Prior to participation, all participants were assured that the research
team was not associated with the District Health Department and that their agreement or refusal to
participate would not influence their relationship with that organization. The interviews involved
a series of questions related to healthy eating, local food purchase decisions, and use of farmers’
markets. Among questions asked were: “How do you define healthy eating?”, “Can you think of
any reasons why you might want to eat fresh produce versus canned or frozen from the
supermarket?”, “Have you visited the local farmers’ market?”, “What do you like and dislike about
the farmers’ market?” Interviews were recorded with a digital recording device with the consent
of the participants and transcribed verbatim. Additionally, notes were taken during the interview.
Data analysis began as soon as the first few interviews were conducted and continued
during data collection, until the point of data saturation was reached (Charmaz, 2006). Data
analysis followed the open, axial, selective coding technique (Strauss, 1987). The trustworthiness
of the study was evaluated based on four main criteria suggested by Charmaz: credibility,
originality, resonance, and usefulness. To insure trustworthiness of the study, the researchers
developed a deep understanding of the topic prior to data collection, ensured the point of saturation
was reached, and discussed results with an independent researcher in the field.
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RESULTS
The following themes were developed as a result of data analysis: a) the perception of
healthy eating by low-income families of rural Appalachia; b) the attitudes of low-income families
in rural Appalachia toward their local farmers’ market; and d) facilitators to increased use of
farmers’ market among low-income families in rural Appalachia. Each of the four themes had
several subcategories.
The Perception of Healthy Eating
To understand the perception of healthy eating among low-income families in rural
community, participants were asked to share their definition of healthy eating. They were also
asked whether they believed they were eating healthy.
Views on healthy eating. Out of 15 participants, 8 had a rather deep understanding of what
it means to eat healthy. For instance, many of them mentioned having a balanced approach to
eating, rather than simply identifying specific products one should or should not consume. As
Respondent 1 explained her definition of healthy eating was related to “Balanced meals with
protein, a carb, a vegetable, a fruit, a dairy.” In addition, the participants demonstrated an
understanding of the importance of nutritional value, freshness, portion control, and the way food
was produced and preserved. Several participants described healthy and fresh food as having
“more nutrients,” “less extra ingredients and preservatives,” and “better flavor and texture.”
Similarly, they were able to name a variety of healthy foods besides fruits and vegetables, such as
whole grains, legumes, and meat. As Respondent 7 explained,
Healthy to me means pesticide, hormone, or antibiotic free, […] organic as much as
possible, fruit and vegetables on a regular basis, not a lot of fatty stuff, not a lot of processed
foods. I mean we don’t have soda or potato chips in our house. Healthy eating is consuming
things that have nutritional value. That means avoiding empty calories and being filled with
toxins. That’s a big deal to me.
Six of the seven remaining participants provided a rather general definition of healthy
eating. That is, they understood the value of eating fruits and vegetables and the disadvantage of
eating a lot of heavy food, salt and sugar. For example, Respondent 8 explained, “Cut back on
sweets, lower salt. Probably just eating things you know you should eat, traditionally, fruits and
vegetables, skim milk…things with less fat. I always heard to eat at the outside of the grocery store
rather than inside, like more packaged food is inside.” Respondent 4 also listed several foods she
perceived as unhealthy, “I would cut out all that cheese and a lot of greasy stuff and fried stuff that
they all like.”. However, while most of these participants had a general understanding of what
represents healthy or unhealthy food, their knowledge of healthy eating behavior was rather
limited. Moreover, healthy eating was perceived as an addition to current less-than-favorable
behaviors, rather than the substitution of negative behaviors with a healthier lifestyle. For
example, Respondent 10 said, “Probably like eating fruits and vegetables and stuff WITH your
meal.”
Responses from the fifteenth participant, on the other hand, suggest she had a very limited
understanding of what it means to eat healthy. When asked to define healthy eating, she did not
name specific foods or eating behaviors that could be considered healthy. Moreover, she did not
seem to believe in the importance of healthy eating. When asked to define healthy eating
Respondent 2 said,
It depends on your body type. I always think, it just depends on what your needs are. I
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mean you have the nutrition guides and things like that but, then again, some people are
required to have more meat, some people are required to have more sugar, in some cases,
it’s weird. To me it just depends on your body type and whatever is healthiest for you.
In addition, Respondent 2 believed she did not have a way to store produce, “I mean I think one
of our main problems with not being able to get the produce is we’re not able to keep it as long so
just because, it goes bad really quickly.”
Perceptions of their own eating. When asked whether they believed their own patterns of
eating were healthy, six participants reported with confidence that they were eating healthy, while
nine were not as confident. Those who were not positive, reported they were trying to eat healthy
but thought they could do a better job. They named such constraints to eating healthy as being
tight on money, not having enough time to cook healthy meals, having a sweet tooth or preference
for junk food, and the needs and preferences of their children. For example, Respondent 6 shared,
“I don’t always eat the healthiest. Sometimes especially when you’re tight on money, it’s hard to
eat healthy, but we try especially since I have a 2 year old daughter, I try to feed her as healthy as
I can. I myself tend to eat junk food too much and drink too much soda.” Respondent 2 expressed
similar concern,
We try but it’s mainly because of our schedules like some of the opportunities aren’t there,
like we can’t sit down and make a decent meal before we go to work cause we both work
third shift so we’re normally asleep right up until. We have to get out of the shower and go.
And then when we get back it’s normally you like eat something small and go to bed and
then repeat the process the next day.
Besides being limited in time or money and just having a preference for less healthy food,
one of the participants mentioned gender and the preferences of her children as a constraint to
healthy eating. As Respondent 3 stated, “I have a toddler and all he wants to eat is peanut butter-
jelly and pizza.” Respondent 4 had similar view, “I try not to eat a lot of red meat but I have 3
guys in the family that are over 6 feet tall and they are meat and potatoes. But we could do a lot
better.” It is not clear whether Respondent 4 believed that healthier food could not provide enough
calories to satisfy the appetites of four grown men (her husband and 3 sons) or whether she did not
think she could afford to feed them healthier foods.
Attitudes toward Local Farmers’ Markets
The attitudes of low-income families in rural communities toward local farmers’ markets
were also explored. In this case, interviewees were asked to describe their visitation patterns to
farmers’ markets, as well as their views on what they liked and disliked about farmers’ markets.
Visitation pattern. Out of 15 participants, only five had visited a farmers’ market at least
once. The frequency of visitation varied between the participants, with only one of the
interviewees reporting regular visitation (6-8 times per season) and the rest of them visiting
occasionally (1-3 times per season). Half of the participants who had never visited a farmers’
market (5 out of 10) reported that they did not know one was available in the community. Among
those who had never visited the farmers’ market in the area but were aware of its existence, one
interviewee said she “didn’t have a chance,” whereas the rest named several constraints that had
stopped them from visiting a farmers’ market, including inconvenient work schedules and farmers’
market hours of operation, weather, and issues related to childcare. For example, Respondent 4
explained that it was hard for her to go to a farmers’ market because she is raising her grandson.
She said,
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It’s just hard, I am raising my grandson and getting him out of car-seat and watching him
while I pick out fruits that might be near the road. He is typical 3 years old and gets on
everything. It’s a little harder. If I were alone I’d probably stop more than with my
grandson. Although it’s fun to shop with him for fruits and vegetables because he loves
them!
Other constraints, those associated with work schedules and the inconvenient operating
hours and location of the farmers’ market, were discussed by Respondent 7, “My schedule honestly
is crazy. It’s time. Our grocery shopping is like let’s run to do that because we’re here right now.
It’s usually kind of a rushed thing. I’m not sure.” Rainy weather and uncertainty whether the
farmers’ market would be open were other reasons given as to why some people did not visit a
local farmers’ market.
Advantages and disadvantages of farmers’ markets. Besides describing their patterns of
visitation to the farmers’ markets, interviewees were also asked about their impressions about
farmers’ markets, as well as what they liked and disliked about them. The majority of participants
had a very positive image of farmers’ market. They enjoyed supporting the local economy,
appreciated healthy food, enjoyed the atmosphere and a sense of community at the farmers’
markets, and found the outdoor setting of the farmers’ market to be appealing setting. In addition,
they recognized that they enjoyed an element of suspense provided by farmers’ markets.
Most of the interviewees who reported having visited a farmers’ market at least once during
the previous season indicated that the reasons they attended were because they wanted to support
local farmers and buy good quality food that was “fresh, local, good, home-grown, and healthy”
(multiple participants). In addition to the opportunities to purchase fresher, better food and to
support the local economy, people reported that they enjoyed visiting farmers’ markets because
they felt a sense of community. For example, Respondent 1 said, “I like that it’s the local people
and I like that it’s normally a better mix of people than there is at Walmart or the supermarket.
People are a little more friendly; a little more apt to inspire you to buy their products.” Another
participant, Respondent 15, discussed how the shared values about eating healthy and local food
helped to create sense of community, “Everybody who is there eating healthy too and most of them
have something in common about trying to buy locally grown food.”
The interviewees also enjoyed the atmosphere at the farmers’ markets. Many of them
described the atmosphere as “not rushed and stressful, fun, lively and entertaining, jovial, friendly,
nice, laid back, welcoming” (multiple participants). Live music, face painting for the kids, and the
general attitude of people at the farmers’ market were among those components identified as
helping to create such a relaxed, leisurely atmosphere. As Respondent 1 described, “It’s a happier
place to be than the supermarket really. People are just in a better mood and they are more
community oriented and you feel better contributing to the community so it’s just a better feeling.”
The fact that the local farmers’ markets are located outside supported an additional factor
that encouraged people to visit them. For example, Respondent 15 described the atmosphere at
the farmers’ market as follows, “There are a lot of kids with their parents so when you bring your
kids to the farmers’ market too, you get to shop for a good food while your kids get to play outside
a little bit and hang out with other people.” Lastly, an element of suspense appeared to be a facet
of farmers’ markets that was appreciated by interviewees. As Respondent 5 shared, “[I like to] just
going and not knowing what’s going to be there.” Another interviewee – Respondent 13 – found
it exciting to try new foods and explore other products that are offered at the farmers’ market along
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with food, “They have like tasters of bread that we could try and that was fun. […] Looking at all
the cool things that people have made, I think there were like hats and jewelry and little girls
dresses there that people had made locally.”
While the majority of interviewees’ opinions about farmers’ markets were positive, there
were also several people who shared things they disliked about farmers’ markets. Among the most
often mentioned disadvantages were the farmers’ markets prices and inconvenience as a result of
location and operational hours. Four participants indicated they felt that farmers’ markets were
too expensive. As Respondent 5 explained, “I would buy everything local if I could, but I can’t
afford it unfortunately, particularly like meat. Meat and dairy seem to be a lot more expensive
when you try to buy local.” Respondent 2 also expressed her frustration, “I would like to be able
to go to the farmers’ market and not have to break the bank for it.”
Five interviewees also mentioned inconvenient work hours as a constraint to why they did
not shop at farmers’ markets. Because farmers’ markets in the area only operate seasonally, on
Saturday mornings, respondents indicated they were unable to shop there on a regular basis. For
example, Respondent 8 said, “It’s only open on Saturday so I can’t get there as often with my work
schedule.” Along with work responsibilities, interviewees mentioned that they wished it was open
more often than once a week and that they often just did not want to wake up early on Saturday
morning. Lastly, two participants indicated that they believed the local farmers’ markets were too
crowded and “could definitely be bigger” (Respondent 4).
Facilitators to the Increased Use of Farmers’ Markets
The interviewees provided several suggestions for improving their experiences at farmers’
markets and increasing their visitation. Among these changes were the addition of multiple
locations (potentially close to supermarkets and in more “children friendly” locations far from the
roads), an adjustment of the schedule to a more convenient one, better promotion (particularly in
local businesses and newspapers), lower prices and the provision of cost-saving opportunities, an
ability to use debit cards at the markets, the installment of tents or roofs to protect the farmers’
markets from rain so they could be open more regularly, and the promotion of farmers’ market to
additional target markets, including low-income families and people who do not typically visit
farmers’ markets.
CONCLUSION
The results of this study support previous research (Farmer et al., 2014) suggesting that
socio-economic status might be a factor influencing visitation of farmers’ markets on a regular
basis. Five out of 15 participants of this study said they visited farmers’ market at least once but
only 1 participant visited farmers’ market on a regular basis. While this finding should be taken
critically due to a small sample of this project, the main goal of the study was to explore the reasons
behind low visitation among low-income families in rural Appalachia and factors that could
facilitate their visitation.
In order to explore potential differences in understanding the importance or value of
healthy and fresh food, participants were asked several questions about their knowledge and
attitude toward healthy eating. Results showed that most of the participants from this study had
either “general” (6 participants) or “deep” understanding (8 participants) of what represents
healthy eating and wanted to improve their own pattern of eating. Similarly, according to a report
by the Share Our Strength and APCO Insight (2012), low-income families were interested in
145 Privilege of Healthy Eating: A Qualitative Study Exploring the Local Food Choices of
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learning more tips and strategies to plan and prepare healthy meals that are easy to cook, affordable
and tasty. Interestingly, while the pervasive belief may be that low-income families often eat fast-
food, both participants from this study and the report by the Share Our Strength and APCO Insight
(2012) claimed to cook dinners from scratch on a regular basis. Thus, we can conclude that, for
our participants, a negative attitude towards healthy eating was not among the major constraints to
farmers’ market visitation. Moreover, the participants of this study reported that healthy food
tasted better, which shows an advanced attitude beyond the necessity and importance of healthy
food to its desirability and the enjoyment of eating healthy. This finding suggests a more
intrinsically motivated behavior with more chances to establish long term patterns of behavior than
extrinsically motivated behavior (Ryan & Deci, 2000).
Unfortunately, despite a rather clear understanding of the benefits of eating healthy, many
of the participants mentioned multiple constraints, including high prices, lack of time to buy and
cook healthy meals, having a sweet tooth or preference for junk food, and the needs and
preferences of their children. Although multiple studies reported that time and money are among
the most important constraints for healthy eating (Farmer et al., 2014; Pelletier & Laska, 2012), it
is important to continue to exploring these and other constraints towards healthy eating and
behavioral change. While in many rural areas and inner-city communities, often defined as food
deserts, access to healthy food is limited (USDA, 2010; Weinberg, 2000), this study showed that
even in communities not identified as food deserts, multiple environmental constraints may
prevent low-income residents from accessing healthy food and farmers’ markets. Potentially, the
simple proximity to the food source and the availability of a car in the household are not the best
indicators of a food desert. The same characteristics of the physical environment (location, hours
of work, prices, etc.) may be experienced differently by people from different SES. Inflexible
schedules, unreliable transportation and lack of social support systems may significantly limit
one’s ability to visit farmers’ market and benefit from its multiple resources.
This study aimed not only to understand reasons behind low visitation of farmers’ markets
by low-income residents of rural communities but also to find potential solutions to this issue. The
participants in this study reported generally positive attitudes toward local farmers’ markets.
Participants mentioned multiple factors that made farmers’ market visitation an enjoyable
experience for them, including enjoyment from supporting local economy, appreciation of healthy
food, enjoyment of atmosphere and sense of community at farmers’ market, as well as outdoors
setting and surprise factor offered by farmers’ market. Using the findings from this study,
administrators of farmers’ markets can create enjoyable and utilitarian environments that could
serve as locations for buying healthy food and serve as local community centers that bring residents
of different backgrounds together (Johnson, 2013). Similar to how community gardens can be
used in cities to integrate people of different racial backgrounds (Shinew, Glover, & Parry, 2004),
community farmers’ markets can serve as spaces for sharing meaningful experiences by members
of different social classes. Moreover, as the participants of this and previous studies claimed
(Famers Market Coalition (2017); Kunkel, Luccia, & Moore, 2003; Ferdinand, Torres, Scott,
Saeed, & Scribner, 2017), farmers’ markets may encourage people to eat healthier and to lead
healthier lifestyle overall. Being surrounded by people who have similar views on healthy eating,
spending time outside while shopping, trying new produce and learning about the origins of
healthy food may create a sense of community and even empowerment among those whose
environment might be less supportive of healthy eating. Moreover, learning about opportunities
146 Privilege of Healthy Eating: A Qualitative Study Exploring the Local Food Choices of
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to save money by purchasing discounted produce and learning new ways to cook it, can help to
change attitude toward healthy eating from pricy and time-consuming to economic and enjoyable
(Larsen & Gilliland, 2009).
Based on facilitating factors reported by the participants of this study, there are several
recommendations to increase visitation of farmers’ markets by low-income families in rural
communities. First, moving the farmers’ market to a location with a roof and even some indoor
space, as well as providing multiple convenient locations, might allow for a more consistent
schedule and longer hours. Second, adding activities and entertainment, such as live music and
activities for children, as well as ensuring a child-friendly environment, could attract more families
with children. Third, inviting more farmers would ensure more visibility in the community and
higher competition that could encourage lower prices and special deals. Fourth, active promotion
of the farmers’ market as a community hub by using various media and different target groups
could strengthen community and increase visitation and, as a result, encourage a healthier lifestyle.
Lastly, the acceptance of debit cards and multiple ways of payment could facilitate the use of
farmers’ market, by those with low-incomes, on a more regular basis.
While this study has provided some interesting findings, it also had several limitations. First,
while self-reporting may provide useful information, in cases when participants are asked to report
behaviors that might be considered socially-undesirable (i.e., unhealthy lifestyle/ eating), the
observation of actual behaviors could be a more reliable source of information. Unfortunately,
observation was not possible due to the specific focus of this study, which required participants to
identify themselves as low-income residents of a rural community.
The second limitation was associated with establishing rapport between researcher and study
participants. Cultural, education and class differences between the interviewer and interviewees
could have potentially led to a social desirability effect (Bernard, 2000) resulting in participants
reporting what, in their opinion, the researcher wanted to hear. To avoid the social desirability
effect, study participants were reminded at the beginning of each interview that there were no right
or wrong answers and that the researcher was only interested in the participants’ experiences.
The third limitation is related to the notion that participants were a part of the Special
Supplemental Nutrition Program for Women, Infants, and Children that was meant to educate them
about healthy eating. Thus, participants might have been more knowledgeable about the issues of
healthy eating than the population they represent. While this could create misleading results,
participants were asked not only about their knowledge but also about their attitudes, and, as results
showed, they had no issues reporting their own less than healthy eating patterns.
Among some recommendations for future research would be comparative studies on low-
income and middle class residents from both rural and urban areas view farmers’ markets and
healthy and local food choices. We also recommend broadening this research to include
perceptions from the entire family and not just the mothers. Lastly, we think it would be important
to explore the differences between perceived and actual constraints so as to ensure they can be
addressed appropriately. While there is more to be done, this research provides valuable insight
into how low-income residents from a rural setting view healthy eating and farmers’ markets. It
is only from gaining such insights that we can make strides in improving healthy eating behaviors
among all residents.
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