Email updates

Keep up to date with the latest news and content from BMC Public Health and BioMed Central.

Open Access Research article

Developing an agenda for research about policies to improve access to healthy foods in rural communities: a concept mapping study

Donna B Johnson1*, Emilee Quinn2, Marilyn Sitaker3, Alice Ammerman4, Carmen Byker5, Wesley Dean6, Sheila Fleischhacker7, Jane Kolodinsky8, Courtney Pinard9, Stephanie B Jilcott Pitts10 and Joseph Sharkey11

Author Affiliations

1 Nutritional Sciences, University of Washington, 98195, Box 353410, Seattle, WA, USA

2 Center for Public Health Nutrition, University of Washington, 98195, Box 353410, Seattle, WA, USA

3 Battelle, Health & Analytics, 1100 Dexter Avenue N., Suite 400, 98109 Seattle, WA, USA

4 Department of Nutrition, Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, CB# 7426, 1700 MLK/Airport Rd, Room 239, 27599–7426, Chapel Hill, NC, USA

5 Department of Health and Human Development, Montana State University, 222 Romney Gym, 59717 Bozeman, MT, USA

6 United States Department of Agriculture Food and Nutrition Service, Office of Policy Support, Food, Nutrition and Consumer Services Headquarters, 3101 Park Center Drive, 22302 Alexandria, VA, USA

7 Division of Nutrition Research Coordination, National Institutes of Health, Two Democracy Plaza, Room 635 6707 Democracy Boulevard MSC 5461, 20892-5461 Bethesda, MD, USA

8 Department of Community Development and Applied Economics, University of Vermont, 202 Morrill Hall, 05405 Burlington, VT, USA

9 Gretchen Swanson Center for Nutrition, 8401 W Dodge Rd, Suite 100, 68114 Omaha, NE, USA

10 Department of Public Health, East Carolina University, 600 Moye Blvd., Mailstop 660 Lakeside Annex Modular Unit 8, Room 126, 27834 Greenville, NC, USA

11 Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, School of Public Health, MS 1266, 77843-1266 College Station, TX, USA

For all author emails, please log on.

BMC Public Health 2014, 14:592  doi:10.1186/1471-2458-14-592

Published: 12 June 2014



Policies that improve access to healthy, affordable foods may improve population health and reduce health disparities. In the United States most food access policy research focuses on urban communities even though residents of rural communities face disproportionately higher risk for nutrition-related chronic diseases compared to residents of urban communities. The purpose of this study was to (1) identify the factors associated with access to healthy, affordable food in rural communities in the United States; and (2) prioritize a meaningful and feasible rural food policy research agenda.


This study was conducted by the Rural Food Access Workgroup (RFAWG), a workgroup facilitated by the Nutrition and Obesity Policy Research and Evaluation Network. A national sample of academic and non-academic researchers, public health and cooperative extension practitioners, and other experts who focus on rural food access and economic development was invited to complete a concept mapping process that included brainstorming the factors that are associated with rural food access, sorting and organizing the factors into similar domains, and rating the importance of policies and research to address these factors. As a last step, RFAWG members convened to interpret the data and establish research recommendations.


Seventy-five participants in the brainstorming exercise represented the following sectors: non-extension research (n = 27), non-extension program administration (n = 18), “other” (n = 14), policy advocacy (n = 10), and cooperative extension service (n = 6). The brainstorming exercise generated 90 distinct statements about factors associated with rural food access in the United States; these were sorted into 5 clusters. Go Zones were established for the factors that were rated highly as both a priority policy target and a priority for research. The highest ranked policy and research priorities include strategies designed to build economic viability in rural communities, improve access to federal food and nutrition assistance programs, improve food retail systems, and increase the personal food production capacity of rural residents. Respondents also prioritized the development of valid and reliable research methodologies to measure variables associated with rural food access.


This collaborative, trans-disciplinary, participatory process, created a map to guide and prioritize research about polices to improve healthy, affordable food access in rural communities.

Rural populations; Nutrition; Food systems; Food access; Policy