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.

Project Narrative PMI encounter numerous barriers in the physical and social environment that lead to poor dietary habits contributing to numerous health compromising conditions; however, there is no specific instrument or guiding model to operationalize barriers and environmental factors that impact dietary habits in PMI. This limits the development of effective interventions, and established solutions for those without mobility impairments may be inappropriate or inaccessible. This study will incorporate community engagement strategies to translate constructs from the Ecologic Model of Obesity for PMI to develop items for a self-report instrument to measure multi-level factors that facilitate or inhibit dietary habits in PMI. This study will examine psychometric properties of the newly developed instrument and will assess the usefulness and feasibility of complementing measures of dietary habits with the newly developed instrument.