Project Summary
People with mobility impairments (PMI) are disproportionately affected by diet-related health compromising
conditions such as obesity, hypertension, diabetes, and some cancers compared to those without mobility
impairments. PMI anecdotally report numerous barriers in the physical and social environment that lead to poor
dietary habits; however, currently there is no clear guiding model or specific instrument to operationalize
barriers and environmental factors that impact dietary habits in PMI. This study will aim to address this gap by
using a comprehensive, theoretically and consumer-guided, ecological and dynamic approach to identifying
ecologic factors that contribute to dietary habits in PMI. This study is theoretically guided by the Ecologic Model
of Obesity (EMO), which has been successfully adapted from the Ecologic Model for Physical Activity (EMPA)
and suggests that physical and social environmental factors and processes directly and indirectly impact behavior
change and maintenance. The EMO provides a framework for examining ecologic factors, such as the macro-level
regional design (urban vs. rural) that can foster access and equity to nutritious foods; micro-level availability and
accessibility of goods and services in the neighborhood and home; and dynamic linkages like social processes,
such as access to support (e.g., transportation, personal assistance). The EMO also accounts for individual sense
of personal control, psychosocial factors, severity and complexity of disability, knowledge of healthy dietary
habits, and socioeconomic status. With the guidance of an existing Community Advisory Board (N=6), this
project will use Nominal Group Technique (NGT) groups (N=64 participants) to translate constructs from the
EMO for PMI to identify multi-level factors that facilitate or inhibit healthy dietary habits. Information learned
through NGT groups will be used to develop items for self-report measures of EMO constructs to investigate
multi-level factors that facilitate or inhibit dietary habits in PMI. The instrument will be tested and refined via
cognitive interviews (N=20) with a diverse and representative group of community representatives. Last, this
study will use state of the science techniques to conduct a survey (N=500) to examine psychometric properties
and will assess the usefulness and feasibility of complementing measures of healthy dietary habits with the new
instrument. The CAB and supportive partners will help to monitor and achieve multi-ethnic recruitment
milestones, results from development and testing, and dissemination efforts to produce an instrument that is
relevant for Americans living with mobility impairments to guide efforts to promote health equity for PMI.