Table 2.

Barriers to Environmental or Policy Interventions to Promote Physical Activity and/or Healthy Eating in Rural Communities

Barrier	Example of a Supporting Quote
Population size	We don’t have a lot of influence when it goes to the state level if we’re trying to influence state policies because we’re such small communities.
Human capital	One of the challenges that I would say that we have is just a basic workforce challenge that I think is fairly cross-cutting for rural communities in general. I’m the only one in our department that has an actual degree in public health and fewer than 10% of adults in my county have completed any form of college education, so we’re not, you know, most of our community partners don’t necessarily have a lot of in-depth education or formal education and sort of the jobs that they’re doing so they may not have necessarily be exposed to the way this idea and research in the built environment or coordinated school health or promoting worksite wellness and all that. So a lot of what my challenges have been has been building things from scratch.
Culture	They’re [rural people] more independent and they really don’t want government messing with them.
Evidence from urban and suburban contexts	Factories are located on the edge of town. Even if you live in the city [in a rural community] you live separate from that, and it’s not necessarily a walkable community kind of experience to go to work. A lot of people who live in the city [in a rural community], work outside of the county, and a lot of people who work in the city [in the rural community] live in the out-county area. So, I think the average commute time is right around 21 minutes.
Leadership	Getting city council to think of [environmental and policy change around health] as an opportunity, not just to improve our economy and to promote economic development but also to promote a community where people are active and walk and bicycle more, that’s been more of a challenge. And not necessarily a challenge in the sense that I’ve encountered a lot of resistance; it’s just a challenge in that it’s a new way of thinking for a lot of people.