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BATTEN-THESIS-2019.Pdf ENVIRONMENTAL INFLUENCES ON NUTRITIONAL CHOICES OF AFRICAN AMERICAN WOMEN WHO RESIDE IN AN ECONOMICALLY CHALLENGED COMMUNITY: A PHOTOVOICE STUDY A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN THE GRADUATE SCHOOL OF THE TEXAS WOMAN’S UNIVERSITY DEPARTMENT OF HEALTH STUDIES COLLEGE OF HEALTH SCIENCES BY ELIZABETH C. BATTEN, B.A. DENTON, TEXAS MAY, 2019 Copyright © 2019 by Elizabeth C. Batten DEDICATION Dedicated to Renee Pope Nweze, a.k.a. Sister Sauda, who inspired me to keep going on this project, even though she did not live to see it completed. Also, to all the other women of color who are bright stars for their families, friends, and community, taken too soon by chronic disease. ii ACKNOWLEDGMENTS I would like to gratefully acknowledge the many individuals who have contributed to this dissertation. I would like to thank Dr. Katie Crosslin, my first advisor, for suggesting PhotoVoice as a methodology for this project. I would like to thank Dr. Kristin Wiginton, my chair, for shepherding me through the entire thesis process, from prospectus to final submission. I would like to thank Dr. Kimberly Parker for being on my committee as well, and for her sharp insights into the African American community, which helped guide me as I developed and implemented my study, and Dr. Mandy Golman for standing in at the last minute. I would like to thank my academic advisor, Dr. James Hutchison, who encouraged me, guided me, and got out the cattle prod when necessary to help me complete the project! I would also like to thank the Church that agreed to host and promote this study, particularly the Pastor and First Lady, whose positive attitude and enthusiasm bolstered me when personal doubts arose. The researcher has ties to this church through a summer camp for disabled children, which the church sponsors. The church is a very small institution of approximately 30 members. The church was previously housed in a building located behind a residence in the 77021 zip code. During Summer 2017, the church completed building on a new facility outside but near the 77021 zip code. The recruiting, training and discussion took place at this new facility. iii I would especially like to give a big thanks to all the church and community members who were willing to speak to me and educate me about their culture and neighborhood and who believed in the importance of the project. I would particularly like to thank Ms. T. Smith for introducing me to this community and facilitating my project through her contact with other church and community members. Finally, I would like to thank the participants themselves, whose wisdom and insights go far beyond the scope of this study and will influence me as I move forward in my career. Finally, I would like to thank my friends and family. I would like to thank the members of my own church for their support and encouragement. I would like to thank my parents for helping me with many weekly chores that made it possible for me to have time to work on this project. I would like to thank my brother for getting me started with a very helpful, step-by-step book on how to write a master’s thesis. And most importantly, I would like to thank my son for putting up with countless hours of my absence during the entire process. I would not have been able to complete this project without the support of each and every one of these people. iv ABSTRACT ELIZABETH C. BATTEN ENVIRONMENTAL INFLUENCES ON NUTRITIONAL CHOICES OF AFRICAN AMERICAN WOMEN WHO RESIDE IN AN ECONOMICALLY CHALLENGED COMMUNITY: A PHOTOVOICE STUDY MAY, 2019 The purpose of this study was to cooperatively explore how the built environment shapes nutritional behaviors of African American women living in an underserved, urban neighborhood, in order to address the health problem of high levels of obesity-related chronic disease among African American women. The study used Photovoice, a participatory action research (PAR) methodology, to incorporate the knowledge and viewpoint of community members. Participants took photographs of their community and then met in a focus group session to discuss the photographs. The researcher analyzed the focus group discussion and the photographic images using the computer-assisted qualitative data analysis system NVivo 11 to discover themes related to the effect of the built environment on nutritional choices in the target community. This study could be used as a point of departure to design small interventions, as well as to promote a future research direction that is relevant to the community. v TABLE OF CONTENTS Page DEDICATION ............................................................................................................. ii ACKNOWLEDGMENTS .......................................................................................... iii ABSTRACT ................................................................................................................. v LIST OF MAPS ........................................................................................................... x LIST OF FIGURES .................................................................................................... xi Chapter I. INTRODUCTION .................................................................................... 1 The Health Problem ............................................................................. 5 Purpose of the Study ............................................................................ 5 Theoretical Foundations....................................................................... 6 Research Questions ............................................................................ 10 Delimitations ...................................................................................... 10 Participants ............................................................................. 10 Limitations ............................................................................. 10 Assumptions ........................................................................... 11 Definition of Terms............................................................................ 11 Built Environment .................................................................. 11 Participatory Action Research ............................................... 12 Photovoice.............................................................................. 13 II. LITERATURE REVIEW ........................................................................ 15 Background: The Health Problem .................................................... 15 Obesity as a Risk Factor for Chronic Diseases ...................... 15 Prevalence of Chronic Disease .............................................. 17 Prevalence of Obesity ............................................................ 18 Obesity Interventions ......................................................................... 19 General Interventions ............................................................. 19 vi Interventions and African American Women ........................ 20 Targeted Interventions ........................................................... 21 Prior Research .................................................................................... 22 Prior Research on the Effect of the Built Environment on Nutritional Intake ......................................................... 23 Measurement .............................................................. 24 Geographic Areas........................................... 25 Outcome Measures......................................... 26 Underlying Studies..................................................... 27 Prior Qualitative Research ..................................................... 29 Findings of Prior Qualitative Research ...................... 30 Community-Based Participatory Action Research ............................ 33 Photovoice as a Form of Participatory Action Research ....... 36 Summary ............................................................................................ 37 III. METHODOLOGY .................................................................................. 39 Setting ................................................................................................ 39 Target Neighborhood ............................................................. 39 The Church................................................................. 41 Procedures .......................................................................................... 41 Sampling and Recruiting........................................................ 41 Procedures .............................................................................. 42 Training of Study Participants ................................... 42 Collection of Photographic Materials ........................ 44 Focus Group Discussion .................................................................... 44 Preparation ............................................................................. 44 Discussion .............................................................................. 45 Qualitative Analysis of Photographs and Audio-Recorded Discussion ........................................................ 47 Transcription .......................................................................... 47 Coding the Data ..................................................................... 47 Review of Data by Community Members (Member Check)
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