Built Environment and Rural Women: A Case Study Approach

Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)




Obesity is a worldwide concern resulting in disease and disability which disproportionately impacts women and rural populations. Rural women tend to be physically inactive and are at higher risk for obesity. The purpose of this case study was to describe and explain 1) the perceptions of rural women regarding rural built environments conducive to physical activity, and 2) what influences availability, accessibility, acceptability, and maintenance of these built environments for physical activity of rural women. March 2006 through April 2007 data collection occurred in two rural communities with populations of less than 1,000. The ecologic model and feminist underpinnings guided the case study research design and methodology. Sources included 2 women’s focus groups (4 total focus groups, N=26) and 1 city council (2 total focus groups, N=8) in each community; individual interviews (N=l 1); three years of archival data; and two quantitative sidewalk maintenance assessments (conducted during two seasons, winter and summer). A central theme that emerged was adaptation. Rural women constantly adapted to conditions of built environments, seasonal concerns (darkness, climate), wild animals, traffic control issues, other people (safety), and personal needs (child rearing, occupational). Economic resources were limited for both rural communities. Local champions, collaborative efforts (public schools, city, and groups/organizations), and adaptation enabled these rural communities to have some development and ongoing maintenance solutions. Implications for nursing and nurse educators include the need to assess the built environments where consumers of health care reside to determine physical activity options. Local, state, and federal policies need to increase the economic resources available for rural communities for physical activity infrastructure (e.g., sidewalks, trails) since it is known that physical inactivity causes an increase in both morbidity and mortality. Future research comparing the use of public schools by the public for physical activity in suburban, urban, and rural environments should be conducted. Assessment of adaptation skills of rural woman can be used as a cooperative association between the nurse and a rural woman to identify viable options for preventive care and health promotion through physical activity options.

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