Food insecurity is associated with high rates of obesity and morbidity and mortality. The goal of food programs is to reduce food insecurity. Inaccurate data and decreased participation in food programs minimizes impact. Rural Appalachia has disproportionally higher rates of food insecurity than non-Appalachian areas. This region also has unique cultural norms that pose challenges in addressing food-insecurity issues.
The purpose of this qualitative study in rural Appalachia was to explore cultural issues related to food insecurity and childhood hunger.
Study Design, Setting, Participants
Semi-structured interviews were conducted with participants living in rural Appalachia (n = 13) to elicit perceptions of assessments and interventions addressing food insecurity.
Using nVivo software, content analysis was conducted separately by the principal investigator and peer researcher to isolate major themes. Asynchronous themes were discussed and resolved.
Stigma related to self-reliance expectations emerged as a major barrier to reporting food insecurity, childhood hunger, and participation of children in food-assistance programs. These expectations resulted in the fear of being perceived as having poor parenting skills, not providing food for children, fear that child protective services would take the child/ren away due to lack of proper food, concerns about breaking cultural norms of not accepting charity or publicly “airing laundry” and mistrust of government authority.
This study suggests that food security assessments and interventions are likely influenced by the self-reliance, respect for privacy, and the need for earned trust characteristics of the Appalachian culture. Assessment of food security and interventions should be culturally sensitive in order to obtain accurate baseline and post-intervention data, and increase participation in programs. Potential improvements to address stigma-related barriers in data collection and intervention design include omitting questions specific to children since general questions on the HFSSM accurately measure household food insecurity, and interventions with a community-based design.