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Using focus groups (n = 6) from six West Virginia counties we assessed how low income, rural women (n = 30) enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) program perceived the food environment and the ability to access healthy food.

For WIC clients who are at risk for nutrition problems and live at or below 185% of poverty, challenges with food access threaten the positive aspects and impacts of the WIC program.

We undertook a qualitative analysis by coding the focus group data on rural food access, into three themes. Our analysis demonstrated how the three major themes interact with five dimensions of food access and underscores the issues with food access that decrease the effectiveness of the food packages and nutrition education that low income WIC participants receive. To increase food access we recommend creating a formal structure where vendors and low income clients may discuss concerns; encouraging greater investment in rural communities through state issued incentives to build full service grocery stores or informal transportation networks; and additional research on the status of low income clients as social change agents capable of addressing issues that act as barriers to their shopping experiences. However, even with the data and prior literature, the pathways by which these environmental factors shape nutrition remain unclear-entangled- much like the issues that low income, rural residents must juggle when they make grocery shopping and nutrition decisions. (C) 2016 Elsevier Ltd. All rights reserved.