Environmental Influences on Physical Activity Among Young Rural Women: A Qualitative Study

Environmental Influences on Physical Activity Among Young Rural Women: A Qualitative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Environmental Influences on Physical Activity Among Young Rural Women: A Qualitative Study Karen Webb, Jongwon Lee This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9418304/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Environmental factors, including the built and social environments, shape physical activity. However, it is less clear how young rural women experience these influences in daily life. This study aimed to understand perceived barriers and facilitators to active lifestyles. Methods A descriptive qualitative design was used to explore environmental influences on physical activity among young rural women. Nineteen participants completed individual semi-structured interviews. Data were analyzed using inductive thematic analysis. Results Four main themes were identified: the built environment, natural and geographic environment, structural environment, and social environment. Participants mainly described barriers, such as limited access to facilities, transportation challenges, cost, poor infrastructure, safety concerns, social support and weather-related issues. Conclusion Rural environments can limit physical activity for young women but also offer support for active lifestyles. These findings highlight the need to address barriers and to leverage existing support in rural communities. This study may help guide targeted strategies to promote physical activity among young rural women. Environmental factors Physical activity Barriers and facilitators Rural women’s health Qualitative research Background Maintaining an active lifestyle is a key health behavior that significantly influences overall health and well-being, with well-established benefits for preventing chronic disease and improving quality of life. The relationship between physical activity and health is dose-dependent, with even small amounts of activity providing measurable benefit [ 1 , 2 ]. Even with widespread promotion of physical activity, Centers for Disease Control and Prevention (CDC) surveillance data show that participation remains low. Approximately one-half of adults meets recommendations for aerobic physical activity, while only one-quarter meets recommendations for both aerobic and muscle-strengthening activities [ 3 , 4 ]. This is a public health concern because physical inactivity is a leading modifiable risk factor for morbidity and premature mortality and is associated with an increased risk of cardiovascular disease and other chronic diseases[ 5 – 8 ]. Physical activity is defined as any bodily movement produced by skeletal muscles that results in energy expenditure and includes everyday activities such as walking, household tasks, and other forms of movement commonly performed in daily life[ 9 ]. In this study, physical activity primarily reflected participants’ descriptions of walking and other forms of movement embedded in daily routines. Importantly, the burden of physical inactivity is not equally distributed, with some populations experiencing lower activity levels and greater barriers to participation. Women face unique challenges related to social roles, safety concerns, and competing responsibilities that may limit their ability to maintain an active lifestyle[ 10 – 12 ]. In the United States (U.S.), the prevalence of meeting recommended physical activity guidelines is lower among women than men, at 20.4% and 28.3%, respectively[ 3 , 13 ]. Among women, adherence to physical activity guidelines also declines with age, with notable reductions observed during midlife and later adulthood[ 3 , 14 ]. These challenges may be further intensified in rural environments, where limited infrastructure, fewer resources, and geographic isolation restrict opportunities for physical activity[ 15 – 17 ]. Approximately 15% to 20% of the U.S. population lives in rural areas [ 18 – 21 ], accounting for nearly 60 million people[ 22 ]. Despite the size of this population, much of the research on physical activity behavior has been conducted in urban and suburban populations with comparatively less attention given to rural contexts[ 23 – 25 ]. Previous research examining rural health barriers has highlighted the need for a greater understanding of environmental factors that influence physical activity in rural communities, particularly among women [ 20 , 21 , 25 , 26 ]. In rural communities, environmental factors including access to resources, infrastructure, safety, and geographic conditions play an important role in shaping opportunities for physical activity. Such factors may create unique barriers or supports for movement in daily life, particularly for young women living in rural areas. Therefore, this study examines how environmental influences shape young rural women’s opportunities for physical activity within the communities where they reside. Methods Study Design A qualitative descriptive design was used [ 26 ], informed by methods described by Patton [ 27 ]. This approach was appropriate as the study aimed to explore the lived experiences of physical activity among young rural women [ 26 ] and to examine the meanings and descriptions of physical activity in their everyday lives[ 28 ]. Data were collected using semi-structured interviews, which allowed the researcher to address key study aims while also providing participants with the opportunity to elaborate on their experiences of physical activity in rural settings[ 27 ]. Setting This study was conducted in McDowell County, West Virginia, a rural Appalachian region located in the southeastern United States[ 28 ]. The county is classified as medically underserved and experiences high levels of poverty, along with a substantial burden of chronic disease[ 29 , 30 ]. The built and natural environments of the region may shape opportunities for physical activity in important ways. McDowell County is characterized by mountainous terrain, winding roads, and geographically dispersed communities, many of which are in areas locally referred to as “hollers,” or narrow valleys between mountains where homes are situated[ 31 ]. In addition, variability in access to sidewalks, safe walking areas, and recreational spaces may further influence opportunities for physical activity[ 15 , 32 , 33 ]. West Virginia also experiences significant health disparities, ranking among the highest in the nation for heart disease, obesity, mental health conditions, diabetes, and cancer[ 34 , 35 ]. These broader contextual factors may further shape health behaviors, including physical activity within rural communities. Sample and Recruitment Participants were informed prior to the interviews that their responses would be audio-recorded and kept confidential. This analysis draws data from a larger qualitative study, and participant demographic characteristics are presented in Table 1 . The sample included 19 young women, similarly, distributed across the two age groups (i.e., 25–29 years old and 30–34 years old). Participants were predominantly White and represented a wide range of educational attainments, household income, and employment status. Most participants had children. These characteristics provide context for interpreting how physical environmental factors may influence opportunities and experiences for physical activity among young women living in this rural Appalachian community. Table 1 Participant Characteristics ( N = 19) Characteristic n % Age at interview 25–29 years 9 47.3 30–34 years 10 52.6 Race/ethnicity White 18 94.7 Hispanic 1 5.3 Education High school 12 63.2 Some college or college degree 7 36.8 Annual household income Less than $ 25,000 8 42.1 $ 25,000– $ 49,999 3 15.8 $ 50,000 or more 8 42.1 Employment status Employed 11 11 57.9 Unemployed 8 42.1 Number of children 0–1 6 31.6 2–3 10 52.6 4 or more 3 15.8 Semi-structured Interview Procedures Interview questions were intentionally broad and exploratory to allow participants to guide the discussion based on their lived experiences and perceptions of environmental influences on their well-being. Interviews were conducted flexibly and responsively according to participant flow, but were generally organized around several key topic areas: Places where participants were most physically active Perceived physical environmental barriers and facilitators to activity Features of the local environment, including access to space, weather, and surrounding conditions Perspectives on how their communities could better support physical activity among women Interviews were conducted at a local community center or in participants’ homes, according to participant preference. Each interview was audio-recorded with a digital voice recorder and transcribed verbatim by a transcriptionist. Field notes were documented following each interview to capture additional contextual observations, reflections, and impressions. At the conclusion of each interview, participants were given the opportunity to ask questions and received a $ 35 gift card to a local convenience store as appreciation for their time. The semi-structured interview guide was developed by the research team to address the study aims, with a focus on environmental influences on physical activity; the full interview guide is provided as Supplementary File 1. Data Analysis Data were analyzed using an inductive thematic analysis approach as described by Braun and Clarke[ 36 , 37 ]. Transcripts were reviewed multiple times to achieve familiarity with the data. Initial codes were generated from patterns identified within participants’ descriptions of their physical environments and their influence on physical activity. Codes were then organized into broader categories and refined into themes that captured shared meanings across participants. The analysis focused specifically on physical environmental influences on physical activity among young rural women. Findings Four themes were identified that describe how the physical environment shaped participants’ opportunities for physical activity. (see Table 2 ). Table 2 Themes and representative quotes describing physical environmental influences on physical activity Theme Description Representative quote Built environment barriers Lack of sidewalks, unsafe road conditions, and poor infrastructure limited opportunities for outdoor physical activity “ If you was to go walking on the side of the road, you’d risk getting hit… we don’t hardly have anything down here .” Natural and geographic environment Distance and dispersed geography required travel to access safe or suitable spaces for physical activity, weather/seasonal conditions “ I would used to have to drive… to Grundy… because that’s the only closest gym we had. ” Structural environment Lack of available, accessible, and affordable facilities restricted opportunities for engagement in physical activity “ There’s nothing around here… if you get a lot of people in there… you’re standing there most of the time because there’s not much there anyways .” Social environment Concerns related to crime, drug activity, stray animals, and lack of lighting reduced willingness to engage in outdoor activity “ You have to worry about people that’s on drugs… you don’t wanna be out beside the road by yourself .” Built Environment Women described several features of their communities that made being physically active more difficult, but the most frequently cited issue was the lack of safe places to walk, particularly sidewalks. Without sidewalks, routine activities such as walking were often described as difficult and unsafe. You’ve got sidewalks up in Bluefield. .. You’ve got sidewalks everywhere. We don’t hardly have anything here. Um, if you was to go walking on the side of the road, you’d risk getting hit . . . Another woman shared similar concerns about deteriorating roads and sidewalks, describing the environment as unsafe for both her and her children: I don’t like the fact that there is no, a sidewalk or there’s, um, very scary sidewalk or broken-up sidewalk, um, and parts of the road that are actually caving in. On our, our road, there’s a whole section that is, literally, falling, um, off a cliff, and, um, so that’s kind of scary. .. my husband would be super worried if I was riding my bike around town, um, and, you know, I definitely couldn’t do it with the kids because that’s the extra, um, danger for them . Because sidewalks were often unavailable, women described having little choice but to walk on the road. Under those conditions, narrow roads, sharp curves, and unsafe driving patterns made outdoor activity feel especially risky. As one participant explained: Um, and people drive crazy, and of course, sometimes under the influence. And you don’t know like, if you have to use a main road to walk, I mean, you could get hit because you just don’t know if this person ‘cause they’ll swerve, and you just never know. Women also spoke more broadly about the condition of the communities around them. Run-down buildings, neglected spaces, and areas they felt they needed to avoid shaped how they experienced their environment. Um, I would say, uh, you know, the, the downside of the environment is, you know, the, the difficulty with the buildings and that are kind of falling down or, you know, the difficult n-neighborhoods that you kind of avoid . Another woman described the condition of local buildings this way: And half of our buildings is run down and destroyed. .. so you can’t put nothing in them. .. A lot of these buildings need destroyed. They’re pitiful. They’re eyesores . Taken together, these accounts show that the built environment was not just inconvenient; it shaped how women moved through their communities and how safe, appealing, and usable those spaces felt for physical activity. Women also described local parks and playgrounds as reflecting this broader lack of upkeep. Although some recreational spaces were available, they were often described as outdated, poorly maintained, or unappealing. “ And a lot of these abandoned parks, here’s the thing about it. They have old equipment. Nobody wants to take their kid and swing on a swing that looks like it’s gonna fall down. So, then it gets abandoned, and then the drug addicts take over it. Then, you might go, and you might find some needles there. I mean, it’s just-that’s how- that’s how it is-Because there’s no upkeep. Anything around Natural and Geographic Environment Women frequently described long distances and the lack of nearby options as barriers to physical activity. Parks and community centers that were perceived as safe, clean, and enjoyable were often not located within their immediate environment. As a result, many participants reported traveling considerable distances to access better-maintained facilities with more available activities. One participant explained, Um, but I know they had a really good one over at Welch. But it’s about a 30-or-so minute drive to Welch around, you know, the curvy mountain roads, and by the time that you get over, you’re wore out from the ride. In addition to distance, women identified weather as a significant influence on their ability to engage in physical activity. Seasonal conditions such as cold temperatures, rain, and icy weather limited opportunities for outdoor movement and reduced participation in activities such as walking, which was commonly described as a primary form of physical activity. As one participant noted, “I think we do better whenever it’s springtime. .. I think that we work out better at—‘cause we can walk.” This suggests that favorable weather conditions supported increased activity, whereas colder or wetter conditions created barriers. For some women, these challenges were further compounded by caregiving responsibilities. Participants described how taking children out in cold or inclement weather made outdoor activity feel impractical, further limiting opportunities for movement. In addition, geographic features of the rural environment intensified these barriers. Women living outside of town or in more remote areas described curvy mountain roads, long travel distances, and hazardous driving conditions during icy weather as additional obstacles to reaching spaces where they could be active. Together, these findings highlight how natural conditions and geographic features interact to shape physical activity opportunities in rural communities. Weather and terrain not only influenced daily decisions about outdoor activity but also affected access to distant resources, ultimately limiting consistent engagement in physical activity across seasons. Structural Environment Women discussed the lack of available, well-equipped, and family-friendly facilities in their communities, as well as challenges related to transportation, costs, and facility hours. Even when local gyms were available, they were often described as small and lacking sufficient equipment. One participant explained: There’s nothing around here. I mean, like, they just started up this little gym, and to be honest with you, it’s still small. And, you know, if you get a lot of people in there to work out, I mean, you-you’re standing there most of the time because there’s not much there anyways. Beyond gyms, women described a broader lack of amenities in their communities, particularly those that could accommodate families. As one participant said: And it is so hard for them because there is no bowling alleys. There is no skating rinks. There no gyms. There is no arcade rooms that they can go play in because you can’t do nothing . Access was further limited by transportation and financial constraints. One woman added: But most of the time, you know, for me, since I’m working and I have the money to get around, I can get somewhere. You got a few other people around here that doesn’t have the ability to travel to get somewhere, and that does put a damper in things for them sometimes. When asked to clarify, she explained that both lack of transportation and limited financial resources, such as money for gas, made it difficult for some women to engage in physical activity. Women also described how limited hours of operation made existing facilities difficult to use. The narrow window of availability at local gyms created challenges, particularly for those with work or family responsibilities. One woman described the limited availability, explaining: I’m not for sure about Bradshaw’s gym. But the one that we go to in War, it’s only open two days a week, and it’s open from 6:00 to 8:00 . Affordability was also a concern. Even when facilities were available, some women felt that the cost of access limited their ability to use them regularly. One participant explained: Like, I know this one is like $10 to get in, but I think that if you have, like so-food stamps or welfare or something, they should have something for free to come in. ” Another similarly noted, “ In wintertime. .. the gym’s pretty much all you have to go to. .. which aren’t free, so. Social Environment Women reported safety concerns as a major barrier to engaging in outdoor physical activity. These concerns encompassed multiple aspects of the environment, including isolated spaces, heightened vulnerability when alone (particularly for women), drug activity, and stray animals. One participant had this to say: Um, there’d, there’d been cops that were, like, patrolling just because they knew stuff was going on. .. But I don’t trust that it’s, um, as well of a public space, like, a-unless a decent amount of people are there. It’s, like-I feel like if something happened, no one would be there to help, if that makes sense, because the park itself is-there’s a river around it, and you can only access it by the bridge that’s really far away. So, even if, for some reason, like, I’m, I’m at the park section, and the only person that would be able to see or hear is across the river. And so, it would take a really long time to, you know, get over. You can’t, like, go through the river. So, it’s just kind of secluded, kind of, um, almost, you know-I would say it’s kind of creepy if you’re there by yourself… Several participants noted that being alone in outdoor spaces increased their sense of risk and limited their willingness to walk or exercise independently. These women echoed a similar concern: And us, as women, are, you know—we’re scareder than the men to get out here and walk, you know, and try to do our exercising and stuff . Women also described how certain outdoor spaces felt unsafe because they were isolated, secluded, or lacked nearby support. One participant explained that although a local park was available, she did not fully trust it as a public space unless other people were present. She described the park as being surrounded by a river and accessible only by a bridge, making it feel secluded and difficult to escape or get help quickly if something happened. Other participants echoed on similar concerns, emphasizing that being alone in these settings heightened their discomfort. For several women, being female further increased their sense of vulnerability. As one participant shared, “As women, we’re scareder than the men to get out here and walk.” Another explained, “I don’t want to go and just walk through town. I don’t want to go and jog through town because the way things are these days, you know, as a woman, definitely if you’re by yourself.” Concerns related to the drug epidemic were woven throughout women’s descriptions of their communities and often limited their willingness to be physically active outdoors. Participants described fearing encounters with individuals under the influence, particularly when walking alone or using public spaces such as roads and parks. For several women, these concerns were closely tied to personal safety and uncertainty about what might happen if they were approached while outside. One participant explained: Well, for the community you have to worry about, like, people that’s on drugs… trying to take your money… If you’re outside the road or something… stuff like that scares you and you don’t wanna be out… by yourself . Another woman emphasized the unpredictability of the situation and the limited police presence in the community: Well, of course, there’s a big drug problem in McDowell County… and you just never know what they’re gonna do if this person’s high, because a lot of people don’t drive around here. They walk… all hours of the night. We do have police out, but they go home at a certain time . Concerns about stray animals also emerged as a barrier to outdoor physical activity. Several women described fear of encountering loose or aggressive dogs, which made walking or exercising outside feel unsafe. These concerns often discouraged participants from engaging in physical activity, particularly in areas where animal control was limited or absent. One woman said, “But of course, there’s a lot of stray dogs, and some of them are vicious…” Another woman shared similar concerns, stating “As far as walking, you have stray animals too, and there’s nobody to actually come and get them. If it’s a dog or something, you don’t know if it’s gonna bite you or not.” Discussion The purpose of this study was to gain insight into physical activity behaviors in rural communities from the perspective of young women. Findings from this study highlight the central role of environmental factors in shaping physical activity, with barriers related to access, infrastructure, safety, and broader community conditions consistently influencing women’s ability to engage in physical activity. While these findings align with previous research on the built environment, they also reveal important differences in how environmental factors are experienced within rural settings. A key finding of this study was the limited availability within participants’ communities. Women frequently described traveling outside their immediate community to reach safe, usable spaces for physical activity. Prior literature consistently demonstrates that access to facilities, including walking trails, pools, parks, and gyms, is positively associated with higher levels of physical activity[ 38 – 41 ]. For example, having more parks within about a half mile of home is associated with 24 additional minutes of exercise[ 41 , 42 ]. Consistent with this literature, rural residents often face fewer opportunities for physical activity than their urban counterparts[ 42 – 44 ]. These findings highlight the need for innovative and cost-effective strategies to expand access in rural communities. One promising approach is the shared use of facilities through partnerships between schools and community organizations. Shared-use agreements allow community members to access existing resources, such as playgrounds, tracks, and gymnasiums, during non-school hours[ 45 ]. These agreements have been associated with increased participation in physical activity and may represent a practical strategy for improving access to physical activity opportunities in rural communities[ 46 , 47 ]. In addition to access, women reported infrastructure-related barriers that limited opportunities for physical activity, including the lack of sidewalks, narrow winding roads, and deteriorating buildings. Previous studies in rural settings have similarly identified both the absence and the poor condition of sidewalks as barriers to an active lifestyle[ 33 , 43 ]. These limitations are often reflective of broader rural environmental characteristics, including scattered residential patterns and inadequate pedestrian infrastructure[ 48 ]. Beyond these functional barriers, the aesthetic quality of the environment also appeared to influence willingness to engage in physical activity. Consistent with prior research demonstrating that positive perceptions of neighborhood aesthetics are associated with higher levels of activity, participants in this study described deteriorating buildings and homes as reducing neighborhood appeal and making outdoor spaces feel less inviting[ 49 – 51 ]. Women also identified road characteristics as important barriers to walking and other forms of physical activity. Participants described narrow, winding roads and a lack of shoulders as major obstacles to outdoor activity. These conditions heightened safety concerns and made walking near home feel difficult or unsafe. These findings are consistent with previous research showing that road safety concerns and limited pedestrian infrastructure can restrict opportunities for physical activity in rural settings [ 43 , 52 ]. In addition, women described living in mountainous and geographically isolated areas, where steep terrain, narrow roads, and limited infrastructure further restricted opportunities to engage in physical activity. Safety concerns also emerged as a significant barrier to physical activity among participants. Women described multiple factors that contributed to feeling unsafe in their communities, including stray animals, the isolated nature of many outdoor spaces, and drug activity. In rural settings, these concerns may be amplified by geographic isolation and limited infrastructure, which can increase vulnerability and reduce access to immediate help. Many women in this study reported not wanting to be alone while outdoors or walking, suggesting that perceived vulnerability may have further limited opportunities for physical activity. Concerns related to crime and drug activity appeared to heighten this vulnerability, consistent with prior research showing that perceptions of safety influence physical activity behaviors, particularly among women, who may be more sensitive to environmental risks[ 53 – 55 ]. Although the relationship between objective crime rates and physical activity remains inconsistent, perceived safety has been shown to play a more consistent role in shaping engagement in outdoor activity[ 56 ]. Although substance use, physical inactivity, and other behavioral risk factors disproportionately burden rural communities and often co-occur[ 57 ], empirical research directly examining the influence of neighborhood drug activity on physical activity behavior in rural settings remains limited[ 58 ]. Conclusion Overall, this qualitative study highlights the central role of environmental factors in shaping women's physical activity behaviors in a rural Appalachian community. Consistent with prior research, elements of the built and natural environment, including access to resources, infrastructure, and perceptions of safety, emerged as key determinants of physical activity engagement. However, these findings extend existing literature by illustrating how such factors are uniquely experienced in rural settings, where geographic isolation, limited infrastructure, and context-specific safety concerns, including drug activity, further constrain opportunities for engagement. Limitations Several limitations of this study should be acknowledged. First, the sample lacked racial and ethnic diversity, with nearly all participants identifying as White. It is possible that including women from more diverse racial and ethnic backgrounds may have yielded different perspectives on physical activity. Second, the study included a relatively small sample of women (N = 19). However, the sample size met qualitative research standards and was guided by data saturation, defined as the point at which no new themes or insights emerged[ 59 ]. In this study, saturation was reached after 19 interviews. Third, the participants were limited to women aged 25–34 years. As a result, the findings may not reflect the experiences of younger or older women in rural communities. Finally, participants were recruited through convenience sampling in a single rural county in West Virginia, which may limit the generalizability of the findings to other geographic regions or populations. However, the purpose of this study was not to generalize findings or establish relationships between variables, but rather to explore and describe the lived experiences of physical activity among rural women. Implications for Practice Much of the existing physical activity research has not adequately captured the experiences of women, particularly those living in rural communities. Research focused specifically on rural women remains limited, and even fewer studies have explored how environmental and contextual factors shape their physical activity behaviors. Qualitative approaches, such as the individual interviews conducted in this study, provide an important opportunity to gain in-depth insight into the lived experiences of this population. The findings from this study contribute to a more nuanced understanding of the environmental barriers and supports that influence physical activity among rural women, including factors that may not be fully captured by traditional, quantitatively derived measures. This information can inform the development of more contextually relevant assessments and interventions, rather than relying on tools and approaches developed primarily for urban or non-rural populations. Additionally, identifying the specific barriers and facilitators to physical activity in this rural context can support the design and implementation of targeted, community-informed interventions to improve physical activity engagement among rural women. Declarations Ethics approval and consent to participate This study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from the University of New Mexico Institutional Review Board (IRB), Albuquerque, NM. All participants provided informed consent prior to participation. Consent for publication Not applicable. Funding This study received no external funding. Competing interests The authors declare that they have no competing interests. Author Contribution KW conceptualized the study, conducted data collection, performed data analysis. JL contributed to data analysis, provided methodological and scholarly guidance, and critically revised the manuscript..KW and JL reviewed and approved the final manuscript. Acknowledgements The authors would like to thank the participants for their time and contributions to this study. Data Availability The datasets generated and/or analyzed during the current study are not publicly available due to the potential risk of participant identification in a small rural sample. In addition, in accordance with institutional data retention policies and as outlined in the informed consent process, the data were destroyed after the required retention period and are no longer available. References Byrne D. A worked example of Braun and Clarke’s approach to reflexive thematic analysis. Vol. 56. Springer Science and Business, Media LLC. 2021. p. 1391. (Quality & Quantity; no. 56). 10.1007/s11135-021-01182-y Jones N, Dlugonski D, Gillespie R, Dewitt E, Lianekhammy J, Slone S, et al. 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Rural Active Living: A Call to Action 2.0, 10-Year Review and Recommendations to Advance the Field. Vol. 32. Ovid Technologies (Wolters Kluwer Health); 2025. p. 197. (Journal of Public Health Management & Practice; no. 32). 10.1097/phh.0000000000002281 Walia AS, King AC, Campero MI, Garcia DM, Lee RE, Zamora AN. Exploring the Relationship between Built Environment Attributes and Physical Activity in Lower-Income Aging Adults: Preliminary Insights from a Multi-Level Trial. 21. 2024;International J Environ Res public health21(5):607. 10.3390/ijerph21050607 Frost SS, Goins RT, Hunter RH, Hooker SP, Bryant LL, Kruger J, et al. Effects of the Built Environment on Physical Activity of Adults Living in Rural Settings. American Journal of Health Promotion. Volume 24. SAGE; 2010. p. 267. no. 2410.4278/ajhp.08040532. Stewart OT, Vernez Moudon A, Saelens BE, Lee C, Kang B, Doescher MP. Comparing Associations Between the Built Environment and Walking in Rural Small Towns and a Large Metropolitan Area. Vol. 48. 2016;Environment and Behavior48(1):13–36. 10.1177/0013916515612253 Omura JD, Carlson SA, Paul P, Sliwa S, Onufrak SJ, Fulton JE. Shared use agreements between municipalities and public schools in the United States, 2014. 95. 2017;Preventive medicine95:S53–9. 10.1016/j.ypmed.2016.09.026 Pitts SBJ, Keyserling TC, Johnston LF, Smith TW, McGuirt JT, Evenson KR et al. Associations Between Neighborhood-Level Factors Related to a Healthful Lifestyle and Dietary Intake, Physical Activity, and Support for Obesity Prevention Polices Among Rural Adults. 40. 2015;Journal community health40(2):276–84. 10.1007/s10900-014-9927-6 Physical activity guidelines for Americans. U.S. Department of Health and Human Services; 2018. Braun V, Clarke V. Using thematic analysis in psychology. Vol. 3. 2006. pp. 77–101. Cleland V, Hughes C, Thornton L, Venn A, Squibb K, Ball K. A Qualitative Study of Environmental Factors Important for Physical Activity in Rural Adults. PLOS ONE. Volume 10. Public Library of Science (PLoS); 2015. no. 1010.1371/journal.pone.0140659. Whitfield GP, Carlson SA, Ussery EN, Watson KB, Berrigan D, Fulton JE. National-level environmental perceptions and walking among urban and rural residents: Informing surveillance of walkability. Preventive Medicine. Volume 123. Elsevier BV; 2024. p. 101. no. 12310.1016/j.ypmed.2019.03.019. Hu FB. Obesity as compared with physical activity in predicting risk of coronary heart disease in women. 113. 2006;Circulation113(4):499–506. 10.1161/circulationaha.105.574087 Müller C, Paulsen L, Bucksch J, Wallmann-Sperlich B. Built and natural environment correlates of physical activity of adults living in rural areas: a systematic review. Vol. 21. Springer Science and Business, Media LLC. 2024. (International Journal of Behavioral Nutrition and Physical Activity; no. 21). 10.1186/s12966-024-01598-3 Purnell LD, Fenkl EA. Handbook for culturally competent care. 1st ed. Cham, Switzerland: Springer; 2019. 10.1007/978-3-030-21946-8 . Christian H, Knuiman M, Divitini M, Foster S, Hooper P, Boruff B et al. A Longitudinal Analysis of the Influence of the Neighborhood Environment on Recreational Walking within the Neighborhood: Results from RESIDE. 125. 2017;Environmental health perspectives125(7):e. 10.1289/ehp823 U.S. Census Bureau QuickFacts: McDowell County, West Virginia. [Internet]. [cited 2026]. (U.S. Census Bureau.). Available from: https://www.census.gov/quickfacts/fact/table/mcdowellcountywestvirginia/HCN010222 SAELENS BE, SALLIS JF, FRANK LD, CAIN KL, CONWAY TL, CHAPMAN JE et al. Neighborhood Environment and Psychosocial Correlates of Adults’ Physical Activity. 44. 2012;Medicine & Science in Sports & Exercise44(4):637–46. 10.1249/mss.0b013e318237fe18 McDowell County Commission [Internet]. Available from: hthttps://mcdowellcountycommission.com/tps://visitwv.com/about/our-area/mcdowell-county/ Kim B, Hyun HS. Corrigendum to Associations between Social and Physical Environments, and Physical Activity in Adults from Urban and Rural Regions[Osong Public Health Res Perspect. 2018;9(1):16–24]. Vol. 9. 2018;Osong public health and research perspectives9(5):283–5. 10.24171/j.phrp.2018.9.5.11 Rees-Punia E, Hathaway ED, Gay JL. Crime, perceived safety, and physical activity: A meta-analysis. Vol. 111. 2018;Preventive medicine111:307–13. 10.1016/j.ypmed.2017.11.017 Elgaddal N, Kramarow EA, Reuben C. Physical Activity Among Adults Aged 18 and Over: United States, 2020. Hong I, Wilson B, Gross T, Conley J, Powers T. Challenging terrains: socio-spatial analysis of Primary Health Care Access Disparities in West Virginia. Appl Spat Anal policy. 2023;16(1):141–61. 10.1007/s12061-022-09472-0 . Cleland V, Squibb K, Stephens L, Dalby J, Timperio A, Winzenberg T, et al. Effectiveness of interventions to promote physical activity and/or decrease sedentary behaviour among rural adults: a systematic review and meta-analysis. Obesity Reviews. Volume 18. Wiley; 2017. p. 727. no. 1810.1111/obr.12533. Nemoto Y, Brown WJ, Mielke GI, Media LLC. 2024. (International Journal of Behavioral Nutrition and Physical Activity; 21). 10.1186/s12966-023-01540-z Yousefian A, Ziller E, Swartz J, Harlety D. Active living for rural youth: Addressing physical activity in rural communities. J Public Health Manage Pract. 2009;15(3):223–31. 10.1097/phh.0 . Gidlow C, Cerin E, Sugiyama T, Adams MA, Mitas J, Akram M et al. Objectively measured access to recreational destinations and leisure-time physical activity: Associations and demographic moderators in a six-country study. 59. 2019;Health & place59:102196. 10.1016/j.healthplace.2019.102196 CROMARTIE J, DOBIS E, KRUMEL T. MCGRANAHAN D, PENDER J. Rural America at a Glance: 2020 Edition. 1490th ed. Vol. 2020. 2020;Amber waves2020. 10.22004/ag.econ.308140 Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1SemiStructuredInterviewGuide.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 04 May, 2026 Editor assigned by journal 04 May, 2026 Editor invited by journal 04 May, 2026 Submission checks completed at journal 03 May, 2026 First submitted to journal 03 May, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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The relationship between physical activity and health is dose-dependent, with even small amounts of activity providing measurable benefit [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Even with widespread promotion of physical activity, Centers for Disease Control and Prevention (CDC) surveillance data show that participation remains low. Approximately one-half of adults meets recommendations for aerobic physical activity, while only one-quarter meets recommendations for both aerobic and muscle-strengthening activities [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This is a public health concern because physical inactivity is a leading modifiable risk factor for morbidity and premature mortality and is associated with an increased risk of cardiovascular disease and other chronic diseases[\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Physical activity is defined as any bodily movement produced by skeletal muscles that results in energy expenditure and includes everyday activities such as walking, household tasks, and other forms of movement commonly performed in daily life[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In this study, physical activity primarily reflected participants\u0026rsquo; descriptions of walking and other forms of movement embedded in daily routines.\u003c/p\u003e \u003cp\u003eImportantly, the burden of physical inactivity is not equally distributed, with some populations experiencing lower activity levels and greater barriers to participation. Women face unique challenges related to social roles, safety concerns, and competing responsibilities that may limit their ability to maintain an active lifestyle[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In the United States (U.S.), the prevalence of meeting recommended physical activity guidelines is lower among women than men, at 20.4% and 28.3%, respectively[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Among women, adherence to physical activity guidelines also declines with age, with notable reductions observed during midlife and later adulthood[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. These challenges may be further intensified in rural environments, where limited infrastructure, fewer resources, and geographic isolation restrict opportunities for physical activity[\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Approximately 15% to 20% of the U.S. population lives in rural areas [\u003cspan additionalcitationids=\"CR19 CR20\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], accounting for nearly 60\u0026nbsp;million people[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Despite the size of this population, much of the research on physical activity behavior has been conducted in urban and suburban populations with comparatively less attention given to rural contexts[\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Previous research examining rural health barriers has highlighted the need for a greater understanding of environmental factors that influence physical activity in rural communities, particularly among women [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn rural communities, environmental factors including access to resources, infrastructure, safety, and geographic conditions play an important role in shaping opportunities for physical activity. Such factors may create unique barriers or supports for movement in daily life, particularly for young women living in rural areas. Therefore, this study examines how environmental influences shape young rural women\u0026rsquo;s opportunities for physical activity within the communities where they reside.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eA qualitative descriptive design was used [\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e], informed by methods described by Patton [\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e]. This approach was appropriate as the study aimed to explore the lived experiences of physical activity among young rural women [\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e] and to examine the meanings and descriptions of physical activity in their everyday lives[\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e]. Data were collected using semi-structured interviews, which allowed the researcher to address key study aims while also providing participants with the opportunity to elaborate on their experiences of physical activity in rural settings[\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSetting\u003c/h3\u003e\n\u003cp\u003eThis study was conducted in McDowell County, West Virginia, a rural Appalachian region located in the southeastern United States[\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e]. The county is classified as medically underserved and experiences high levels of poverty, along with a substantial burden of chronic disease[\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e]. The built and natural environments of the region may shape opportunities for physical activity in important ways.\u003c/p\u003e \u003cp\u003eMcDowell County is characterized by mountainous terrain, winding roads, and geographically dispersed communities, many of which are in areas locally referred to as “hollers,” or narrow valleys between mountains where homes are situated[\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e]. In addition, variability in access to sidewalks, safe walking areas, and recreational spaces may further influence opportunities for physical activity[\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWest Virginia also experiences significant health disparities, ranking among the highest in the nation for heart disease, obesity, mental health conditions, diabetes, and cancer[\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e]. These broader contextual factors may further shape health behaviors, including physical activity within rural communities.\u003c/p\u003e\n\u003ch3\u003eSample and Recruitment\u003c/h3\u003e\n\u003cp\u003e Participants were informed prior to the interviews that their responses would be audio-recorded and kept confidential. This analysis draws data from a larger qualitative study, and participant demographic characteristics are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. The sample included 19 young women, similarly, distributed across the two age groups (i.e., 25–29 years old and 30–34 years old). Participants were predominantly White and represented a wide range of educational attainments, household income, and employment status. Most participants had children. These characteristics provide context for interpreting how physical environmental factors may influence opportunities and experiences for physical activity among young women living in this rural Appalachian community.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab1\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipant Characteristics (\u003cem\u003eN\u003c/em\u003e = 19)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eAge at interview\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e25–29 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e47.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e30–34 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e52.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003eRace/ethnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e94.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e63.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSome college or college degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e36.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003eAnnual household income\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eLess than \u003cspan\u003e$\u003c/span\u003e25,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e42.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e25,000–\u003cspan\u003e$\u003c/span\u003e49,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e50,000 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e42.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003eEmployment status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eEmployed 11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e57.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e42.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003eNumber of children\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0–1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e31.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e2–3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e52.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e4 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eSemi-structured Interview Procedures\u003c/h3\u003e\n\u003cp\u003e Interview questions were intentionally broad and exploratory to allow participants to guide the discussion based on their lived experiences and perceptions of environmental influences on their well-being. Interviews were conducted flexibly and responsively according to participant flow, but were generally organized around several key topic areas:\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePlaces where participants were most physically active\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePerceived physical environmental barriers and facilitators to activity\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eFeatures of the local environment, including access to space, weather, and surrounding conditions\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePerspectives on how their communities could better support physical activity among women\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e Interviews were conducted at a local community center or in participants’ homes, according to participant preference. Each interview was audio-recorded with a digital voice recorder and transcribed verbatim by a transcriptionist. Field notes were documented following each interview to capture additional contextual observations, reflections, and impressions. At the conclusion of each interview, participants were given the opportunity to ask questions and received a \u003cspan\u003e$\u003c/span\u003e35 gift card to a local convenience store as appreciation for their time.\u003c/p\u003e \u003cp\u003eThe semi-structured interview guide was developed by the research team to address the study aims, with a focus on environmental influences on physical activity; the full interview guide is provided as Supplementary File 1.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using an inductive thematic analysis approach as described by Braun and Clarke[\u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e37\u003c/span\u003e]. Transcripts were reviewed multiple times to achieve familiarity with the data. Initial codes were generated from patterns identified within participants’ descriptions of their physical environments and their influence on physical activity. Codes were then organized into broader categories and refined into themes that captured shared meanings across participants. The analysis focused specifically on physical environmental influences on physical activity among young rural women.\u003c/p\u003e \u003c/div\u003e \n\n \n\n \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003cdiv class=\"BlockQuote\"\u003e\u003c/div\u003e \u003cdiv class=\"BlockQuote\"\u003e\u003c/div\u003e \u003cdiv class=\"BlockQuote\"\u003e\u003c/div\u003e \u003cdiv class=\"BlockQuote\"\u003e\u003c/div\u003e \u003cdiv class=\"BlockQuote\"\u003e\u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003cdiv class=\"BlockQuote\"\u003e\u003c/div\u003e \u003cdiv class=\"BlockQuote\"\u003e\u003c/div\u003e \u003cdiv class=\"BlockQuote\"\u003e\u003c/div\u003e \u003cdiv class=\"BlockQuote\"\u003e\u003c/div\u003e \u003c/div\u003e"},{"header":"Findings","content":"\u003cp\u003eFour themes were identified that describe how the physical environment shaped participants’ opportunities for physical activity. (see Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab2\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThemes and representative quotes describing physical environmental influences on physical activity\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eRepresentative quote\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eBuilt environment barriers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eLack of sidewalks, unsafe road conditions, and poor infrastructure limited opportunities for outdoor physical activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e“\u003cem\u003eIf you was to go walking on the side of the road, you’d risk getting hit… we don’t hardly have anything down here\u003c/em\u003e.”\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNatural and geographic environment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDistance and dispersed geography required travel to access safe or suitable spaces for physical activity, weather/seasonal conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e“\u003cem\u003eI would used to have to drive… to Grundy… because that’s the only closest gym we had.\u003c/em\u003e”\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eStructural environment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eLack of available, accessible, and affordable facilities restricted opportunities for engagement in physical activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e“\u003cem\u003eThere’s nothing around here… if you get a lot of people in there… you’re standing there most of the time because there’s not much there anyways\u003c/em\u003e.”\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSocial environment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eConcerns related to crime, drug activity, stray animals, and lack of lighting reduced willingness to engage in outdoor activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e“\u003cem\u003eYou have to worry about people that’s on drugs… you don’t wanna be out beside the road by yourself\u003c/em\u003e.”\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003ch3\u003eBuilt Environment\u003c/h3\u003e\u003cp\u003eWomen described several features of their communities that made being physically active more difficult, but the most frequently cited issue was the lack of safe places to walk, particularly sidewalks. Without sidewalks, routine activities such as walking were often described as difficult and unsafe.\u003c/p\u003e\u003cp\u003e \u003cem\u003eYou’ve got sidewalks up in Bluefield. .. You’ve got sidewalks everywhere. We don’t hardly have anything here. Um, if you was to go walking on the side of the road, you’d risk getting hit\u003c/em\u003e. . .\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAnother woman shared similar concerns about deteriorating roads and sidewalks, describing the environment as unsafe for both her and her children:\u003c/p\u003e\u003cp\u003e \u003cem\u003eI don’t like the fact that there is no, a sidewalk or there’s, um, very scary sidewalk or broken-up sidewalk, um, and parts of the road that are actually caving in. On our, our road, there’s a whole section that is, literally, falling, um, off a cliff, and, um, so that’s kind of scary. .. my husband would be super worried if I was riding my bike around town, um, and, you know, I definitely couldn’t do it with the kids because that’s the extra, um, danger for them\u003c/em\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eBecause sidewalks were often unavailable, women described having little choice but to walk on the road. Under those conditions, narrow roads, sharp curves, and unsafe driving patterns made outdoor activity feel especially risky. As one participant explained:\u003c/p\u003e\u003cp\u003e \u003cem\u003eUm, and people drive crazy, and of course, sometimes under the influence. And you don’t know like, if you have to use a main road to walk, I mean, you could get hit because you just don’t know if this person ‘cause they’ll swerve, and you just never know.\u003c/em\u003e \u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eWomen also spoke more broadly about the condition of the communities around them. Run-down buildings, neglected spaces, and areas they felt they needed to avoid shaped how they experienced their environment.\u003c/p\u003e\u003cp\u003e \u003cem\u003eUm, I would say, uh, you know, the, the downside of the environment is, you know, the, the difficulty with the buildings and that are kind of falling down or, you know, the difficult n-neighborhoods that you kind of avoid\u003c/em\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAnother woman described the condition of local buildings this way:\u003c/p\u003e\u003cp\u003e \u003cem\u003eAnd half of our buildings is run down and destroyed. .. so you can’t put nothing in them. .. A lot of these buildings need destroyed. They’re pitiful. They’re eyesores\u003c/em\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTaken together, these accounts show that the built environment was not just inconvenient; it shaped how women moved through their communities and how safe, appealing, and usable those spaces felt for physical activity.\u003c/p\u003e\u003cp\u003eWomen also described local parks and playgrounds as reflecting this broader lack of upkeep. Although some recreational spaces were available, they were often described as outdated, poorly maintained, or unappealing.\u003c/p\u003e\u003cp\u003e“\u003cem\u003eAnd a lot of these abandoned parks, here’s the thing about it. They have old equipment. Nobody wants to take their kid and swing on a swing that looks like it’s gonna fall down. So, then it gets abandoned, and then the drug addicts take over it. Then, you might go, and you might find some needles there. I mean, it’s just-that’s how- that’s how it is-Because there’s no upkeep. Anything around\u003c/em\u003e\u003c/p\u003e\u003ch3\u003eNatural and Geographic Environment\u003c/h3\u003e\u003cp\u003eWomen frequently described long distances and the lack of nearby options as barriers to physical activity. Parks and community centers that were perceived as safe, clean, and enjoyable were often not located within their immediate environment. As a result, many participants reported traveling considerable distances to access better-maintained facilities with more available activities. One participant explained,\u003c/p\u003e\u003cp\u003eUm, but I know they had a really good one over at Welch. But it’s about a 30-or-so minute drive to Welch around, you know, the curvy mountain roads, and by the time that you get over, you’re wore out from the ride.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn addition to distance, women identified weather as a significant influence on their ability to engage in physical activity. Seasonal conditions such as cold temperatures, rain, and icy weather limited opportunities for outdoor movement and reduced participation in activities such as walking, which was commonly described as a primary form of physical activity. As one participant noted, “I think we do better whenever it’s springtime. .. I think that we work out better at—‘cause we can walk.” This suggests that favorable weather conditions supported increased activity, whereas colder or wetter conditions created barriers.\u003c/p\u003e\u003cp\u003eFor some women, these challenges were further compounded by caregiving responsibilities. Participants described how taking children out in cold or inclement weather made outdoor activity feel impractical, further limiting opportunities for movement. In addition, geographic features of the rural environment intensified these barriers. Women living outside of town or in more remote areas described curvy mountain roads, long travel distances, and hazardous driving conditions during icy weather as additional obstacles to reaching spaces where they could be active.\u003c/p\u003e\u003cp\u003eTogether, these findings highlight how natural conditions and geographic features interact to shape physical activity opportunities in rural communities. Weather and terrain not only influenced daily decisions about outdoor activity but also affected access to distant resources, ultimately limiting consistent engagement in physical activity across seasons.\u003c/p\u003e\u003ch2\u003eStructural Environment\u003c/h2\u003e\u003cp\u003eWomen discussed the lack of available, well-equipped, and family-friendly facilities in their communities, as well as challenges related to transportation, costs, and facility hours. Even when local gyms were available, they were often described as small and lacking sufficient equipment. One participant explained:\u003c/p\u003e\u003cp\u003e \u003cem\u003eThere’s nothing around here. I mean, like, they just started up this little gym, and to be honest with you, it’s still small. And, you know, if you get a lot of people in there to work out, I mean, you-you’re standing there most of the time because there’s not much there anyways.\u003c/em\u003e \u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eBeyond gyms, women described a broader lack of amenities in their communities, particularly those that could accommodate families. As one participant said:\u003c/p\u003e\u003cp\u003e \u003cem\u003eAnd it is so hard for them because there is no bowling alleys. There is no skating rinks. There no gyms. There is no arcade rooms that they can go play in because you can’t do nothing\u003c/em\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAccess was further limited by transportation and financial constraints. One woman added:\u003c/p\u003e\u003cp\u003e \u003cem\u003eBut most of the time, you know, for me, since I’m working and I have the money to get around, I can get somewhere. You got a few other people around here that doesn’t have the ability to travel to get somewhere, and that does put a damper in things for them sometimes.\u003c/em\u003e \u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eWhen asked to clarify, she explained that both lack of transportation and limited financial resources, such as money for gas, made it difficult for some women to engage in physical activity.\u003c/p\u003e\u003cp\u003eWomen also described how limited hours of operation made existing facilities difficult to use. The narrow window of availability at local gyms created challenges, particularly for those with work or family responsibilities. One woman described the limited availability, explaining:\u003c/p\u003e\u003cp\u003e \u003cem\u003eI’m not for sure about Bradshaw’s gym. But the one that we go to in War, it’s only open two days a week, and it’s open from 6:00 to 8:00\u003c/em\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAffordability was also a concern. Even when facilities were available, some women felt that the cost of access limited their ability to use them regularly. One participant explained:\u003c/p\u003e\u003cp\u003e \u003cem\u003eLike, I know this one is like $10 to get in, but I think that if you have, like so-food stamps or welfare or something, they should have something for free to come in.\u003c/em\u003e” Another similarly noted, “\u003cem\u003eIn wintertime. .. the gym’s pretty much all you have to go to. .. which aren’t free, so.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003ch2\u003eSocial Environment\u003c/h2\u003e\u003cp\u003eWomen reported safety concerns as a major barrier to engaging in outdoor physical activity. These concerns encompassed multiple aspects of the environment, including isolated spaces, heightened vulnerability when alone (particularly for women), drug activity, and stray animals. One participant had this to say:\u003c/p\u003e\u003cp\u003e \u003cem\u003eUm, there’d, there’d been cops that were, like, patrolling just because they knew stuff was going on. .. But I don’t trust that it’s, um, as well of a public space, like, a-unless a decent amount of people are there. It’s, like-I feel like if something happened, no one would be there to help, if that makes sense, because the park itself is-there’s a river around it, and you can only access it by the bridge that’s really far away. So, even if, for some reason, like, I’m, I’m at the park section, and the only person that would be able to see or hear is across the river. And so, it would take a really long time to, you know, get over. You can’t, like, go through the river. So, it’s just kind of secluded, kind of, um, almost, you know-I would say it’s kind of creepy if you’re there by yourself…\u003c/em\u003e \u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eSeveral participants noted that being alone in outdoor spaces increased their sense of risk and limited their willingness to walk or exercise independently. These women echoed a similar concern:\u003c/p\u003e\u003cp\u003e \u003cem\u003eAnd us, as women, are, you know—we’re scareder than the men to get out here and walk, you know, and try to do our exercising and stuff\u003c/em\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eWomen also described how certain outdoor spaces felt unsafe because they were isolated, secluded, or lacked nearby support. One participant explained that although a local park was available, she did not fully trust it as a public space unless other people were present. She described the park as being surrounded by a river and accessible only by a bridge, making it feel secluded and difficult to escape or get help quickly if something happened. Other participants echoed on similar concerns, emphasizing that being alone in these settings heightened their discomfort. For several women, being female further increased their sense of vulnerability. As one participant shared, “As women, we’re scareder than the men to get out here and walk.” Another explained, “I don’t want to go and just walk through town. I don’t want to go and jog through town because the way things are these days, you know, as a woman, definitely if you’re by yourself.”\u003c/p\u003e\u003cp\u003eConcerns related to the drug epidemic were woven throughout women’s descriptions of their communities and often limited their willingness to be physically active outdoors. Participants described fearing encounters with individuals under the influence, particularly when walking alone or using public spaces such as roads and parks. For several women, these concerns were closely tied to personal safety and uncertainty about what might happen if they were approached while outside. One participant explained:\u003c/p\u003e\u003cp\u003e \u003cem\u003eWell, for the community you have to worry about, like, people that’s on drugs… trying to take your money… If you’re outside the road or something… stuff like that scares you and you don’t wanna be out… by yourself\u003c/em\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAnother woman emphasized the unpredictability of the situation and the limited police presence in the community:\u003c/p\u003e\u003cp\u003e \u003cem\u003eWell, of course, there’s a big drug problem in McDowell County… and you just never know what they’re gonna do if this person’s high, because a lot of people don’t drive around here. They walk… all hours of the night. We do have police out, but they go home at a certain time\u003c/em\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eConcerns about stray animals also emerged as a barrier to outdoor physical activity. Several women described fear of encountering loose or aggressive dogs, which made walking or exercising outside feel unsafe. These concerns often discouraged participants from engaging in physical activity, particularly in areas where animal control was limited or absent. One woman said, “But of course, there’s a lot of stray dogs, and some of them are vicious…” Another woman shared similar concerns, stating “As far as walking, you have stray animals too, and there’s nobody to actually come and get them. If it’s a dog or something, you don’t know if it’s gonna bite you or not.”\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe purpose of this study was to gain insight into physical activity behaviors in rural communities from the perspective of young women. Findings from this study highlight the central role of environmental factors in shaping physical activity, with barriers related to access, infrastructure, safety, and broader community conditions consistently influencing women\u0026rsquo;s ability to engage in physical activity. While these findings align with previous research on the built environment, they also reveal important differences in how environmental factors are experienced within rural settings.\u003c/p\u003e \u003cp\u003eA key finding of this study was the limited availability within participants\u0026rsquo; communities. Women frequently described traveling outside their immediate community to reach safe, usable spaces for physical activity. Prior literature consistently demonstrates that access to facilities, including walking trails, pools, parks, and gyms, is positively associated with higher levels of physical activity[\u003cspan additionalcitationids=\"CR39 CR40\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. For example, having more parks within about a half mile of home is associated with 24 additional minutes of exercise[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Consistent with this literature, rural residents often face fewer opportunities for physical activity than their urban counterparts[\u003cspan additionalcitationids=\"CR43\" citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. These findings highlight the need for innovative and cost-effective strategies to expand access in rural communities. One promising approach is the shared use of facilities through partnerships between schools and community organizations. Shared-use agreements allow community members to access existing resources, such as playgrounds, tracks, and gymnasiums, during non-school hours[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. These agreements have been associated with increased participation in physical activity and may represent a practical strategy for improving access to physical activity opportunities in rural communities[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn addition to access, women reported infrastructure-related barriers that limited opportunities for physical activity, including the lack of sidewalks, narrow winding roads, and deteriorating buildings. Previous studies in rural settings have similarly identified both the absence and the poor condition of sidewalks as barriers to an active lifestyle[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. These limitations are often reflective of broader rural environmental characteristics, including scattered residential patterns and inadequate pedestrian infrastructure[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Beyond these functional barriers, the aesthetic quality of the environment also appeared to influence willingness to engage in physical activity. Consistent with prior research demonstrating that positive perceptions of neighborhood aesthetics are associated with higher levels of activity, participants in this study described deteriorating buildings and homes as reducing neighborhood appeal and making outdoor spaces feel less inviting[\u003cspan additionalcitationids=\"CR50\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWomen also identified road characteristics as important barriers to walking and other forms of physical activity. Participants described narrow, winding roads and a lack of shoulders as major obstacles to outdoor activity. These conditions heightened safety concerns and made walking near home feel difficult or unsafe. These findings are consistent with previous research showing that road safety concerns and limited pedestrian infrastructure can restrict opportunities for physical activity in rural settings [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. In addition, women described living in mountainous and geographically isolated areas, where steep terrain, narrow roads, and limited infrastructure further restricted opportunities to engage in physical activity.\u003c/p\u003e \u003cp\u003eSafety concerns also emerged as a significant barrier to physical activity among participants. Women described multiple factors that contributed to feeling unsafe in their communities, including stray animals, the isolated nature of many outdoor spaces, and drug activity. In rural settings, these concerns may be amplified by geographic isolation and limited infrastructure, which can increase vulnerability and reduce access to immediate help. Many women in this study reported not wanting to be alone while outdoors or walking, suggesting that perceived vulnerability may have further limited opportunities for physical activity. Concerns related to crime and drug activity appeared to heighten this vulnerability, consistent with prior research showing that perceptions of safety influence physical activity behaviors, particularly among women, who may be more sensitive to environmental risks[\u003cspan additionalcitationids=\"CR54\" citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Although the relationship between objective crime rates and physical activity remains inconsistent, perceived safety has been shown to play a more consistent role in shaping engagement in outdoor activity[\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. Although substance use, physical inactivity, and other behavioral risk factors disproportionately burden rural communities and often co-occur[\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e], empirical research directly examining the influence of neighborhood drug activity on physical activity behavior in rural settings remains limited[\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOverall, this qualitative study highlights the central role of environmental factors in shaping women's physical activity behaviors in a rural Appalachian community. Consistent with prior research, elements of the built and natural environment, including access to resources, infrastructure, and perceptions of safety, emerged as key determinants of physical activity engagement. However, these findings extend existing literature by illustrating how such factors are uniquely experienced in rural settings, where geographic isolation, limited infrastructure, and context-specific safety concerns, including drug activity, further constrain opportunities for engagement.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eSeveral limitations of this study should be acknowledged. First, the sample lacked racial and ethnic diversity, with nearly all participants identifying as White. It is possible that including women from more diverse racial and ethnic backgrounds may have yielded different perspectives on physical activity.\u003c/p\u003e \u003cp\u003eSecond, the study included a relatively small sample of women (N\u0026thinsp;=\u0026thinsp;19). However, the sample size met qualitative research standards and was guided by data saturation, defined as the point at which no new themes or insights emerged[\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. In this study, saturation was reached after 19 interviews. Third, the participants were limited to women aged 25\u0026ndash;34 years. As a result, the findings may not reflect the experiences of younger or older women in rural communities.\u003c/p\u003e \u003cp\u003eFinally, participants were recruited through convenience sampling in a single rural county in West Virginia, which may limit the generalizability of the findings to other geographic regions or populations. However, the purpose of this study was not to generalize findings or establish relationships between variables, but rather to explore and describe the lived experiences of physical activity among rural women.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Practice\u003c/h2\u003e \u003cp\u003eMuch of the existing physical activity research has not adequately captured the experiences of women, particularly those living in rural communities. Research focused specifically on rural women remains limited, and even fewer studies have explored how environmental and contextual factors shape their physical activity behaviors. Qualitative approaches, such as the individual interviews conducted in this study, provide an important opportunity to gain in-depth insight into the lived experiences of this population.\u003c/p\u003e \u003cp\u003eThe findings from this study contribute to a more nuanced understanding of the environmental barriers and supports that influence physical activity among rural women, including factors that may not be fully captured by traditional, quantitatively derived measures. This information can inform the development of more contextually relevant assessments and interventions, rather than relying on tools and approaches developed primarily for urban or non-rural populations.\u003c/p\u003e \u003cp\u003eAdditionally, identifying the specific barriers and facilitators to physical activity in this rural context can support the design and implementation of targeted, community-informed interventions to improve physical activity engagement among rural women.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e This study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from the University of New Mexico Institutional Review Board (IRB), Albuquerque, NM. All participants provided informed consent prior to participation.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study received no external funding.\u003c/p\u003e \u003cp\u003eCompeting interests\u003c/p\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eKW conceptualized the study, conducted data collection, performed data analysis. JL contributed to data analysis, provided methodological and scholarly guidance, and critically revised the manuscript..KW and JL reviewed and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThe authors would like to thank the participants for their time and contributions to this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to the potential risk of participant identification in a small rural sample. In addition, in accordance with institutional data retention policies and as outlined in the informed consent process, the data were destroyed after the required retention period and are no longer available.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eByrne D. A worked example of Braun and Clarke\u0026rsquo;s approach to reflexive thematic analysis. Vol. 56. 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Rural America at a Glance: 2020 Edition. 1490th ed. Vol. 2020. 2020;Amber waves2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.22004/ag.econ.308140\u003c/span\u003e\u003cspan address=\"10.22004/ag.econ.308140\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Environmental factors, Physical activity, Barriers and facilitators, Rural women’s health, Qualitative research","lastPublishedDoi":"10.21203/rs.3.rs-9418304/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9418304/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEnvironmental factors, including the built and social environments, shape physical activity. However, it is less clear how young rural women experience these influences in daily life. This study aimed to understand perceived barriers and facilitators to active lifestyles.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA descriptive qualitative design was used to explore environmental influences on physical activity among young rural women. Nineteen participants completed individual semi-structured interviews. Data were analyzed using inductive thematic analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFour main themes were identified: the built environment, natural and geographic environment, structural environment, and social environment. Participants mainly described barriers, such as limited access to facilities, transportation challenges, cost, poor infrastructure, safety concerns, social support and weather-related issues.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eRural environments can limit physical activity for young women but also offer support for active lifestyles. These findings highlight the need to address barriers and to leverage existing support in rural communities. This study may help guide targeted strategies to promote physical activity among young rural women.\u003c/p\u003e","manuscriptTitle":"Environmental Influences on Physical Activity Among Young Rural Women: A Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-12 13:45:39","doi":"10.21203/rs.3.rs-9418304/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-05-04T17:06:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-04T17:01:53+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-05-04T12:00:08+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-05-03T20:50:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-05-03T20:45:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"17f2e8ba-bdaa-4b78-a5d6-4773a0d9a34b","owner":[],"postedDate":"May 12th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewersInvited","content":"7","date":"2026-05-04T17:06:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-04T17:01:53+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-05-04T12:00:08+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-05-03T20:50:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-05-03T20:45:29+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-12T13:45:39+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-12 13:45:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9418304","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9418304","identity":"rs-9418304","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}