| This qualitative study explored rural caregivers’ perspectives on facilitators and barriers
to healthy behaviors for childhood obesity prevention in Idaho, focusing on perceived causes of
obesity and strategies used to support nutrition and physical activity in rural environments.
Pediatric obesity remains a major public health concern, with approximately one in three U.S.
children classified as overweight or obese. Rural children face even greater risk and are up to
95% more likely to experience obesity than urban peers (Crouch et al., 2023). Environmental,
socioeconomic, and systemic barriers contribute to these disparities, yet limited research
examines how rural caregivers navigate them in daily life. Guided by the Roy Adaptation Model
(RAM), semi-structured virtual interviews were conducted with caregivers of children aged 8–12
years living in rural Idaho. Interviews were transcribed verbatim and analyzed using a
combination of directed and conventional thematic coding supported by Atlas.ti, with
participants recruited through convenience and snowball sampling.
Fifteen caregivers participated in the study. Findings revealed adaptive challenges across
physiologic, self-concept, role function, and interdependence modes. Caregivers managed
comorbidities amid limited food access, scarce physical activity resources, and distant healthcare
services. Emotional strain, stigma, and sustained advocacy within fragmented systems were
common, while family and community supports variably influenced adaptation. Rural pediatric
obesity caregiving was shaped by geographic isolation, structural barriers, limited healthcare
access, and persistent stigma. These findings support the need for multi-level, family-centered
interventions that address environmental constraints and improve cross-system coordination in
rural settings.
Keywords: obesity, overweight, childhood obesity, rural, Idaho, children 8–12 years,
parental/caregiver involvement, healthy behaviors |