A focus group session, using the Theory of Planned Behavior to guide questions and discussion, was conducted at midpoint of a 12-month cooking skills program in a rural Appalachian food desert. The purpose of this qualitative study was to determine the attitudes, subjective norms and perceived behavioral control beliefs that influenced participation in these classes. Participants viewed the classes as opportunities for social interaction and to have new experiences. Subjective norms were influenced by family members and traditional cooking. Perceived behavioral control was influenced by the opportunity to try new foods without concern of food waste, acquisition of the knowledge to introduce healthy foods into family meals and enhanced food preparation skills. During the evaluation, a strong sense of participant appreciation of researcher presence was discovered. This unexpected positive component of the program will be promoted using motivational interviewing techniques to enhance adherence to healthy eating behaviors during and after cooking skills programs.

Promotion of healthy eating is an effective public health strategy to prevent chronic disease incidence and progression. However, food prices can impede healthy eating, especially in rural communities. The purpose of this study was to determine whether food costs are associated with nutritional quality, geographic location, and month of year. The Overall Nutritional Quality Index and cost of 92 foods were assessed four times over a 10-month period in the primary grocery stores in four Kentucky counties, two rural and two urban. Repeated measures analysis of variance was used to assess differences in food costs by nutritional quality, county, and month. Among more nutritious food items, costs were lower in urban areas. This was particularly true among foods in the highest quartile of nutritional quality. Across all counties, there was a pattern of highest per-serving costs in the second quartile of nutritional quality, whereas more nutritious foods were less expensive. Strategies that help individuals improve the ability to identify and prepare less costly foods with high nutritional value may be effective in improving dietary habits, particularly in rural, impoverished food deserts.