Project Summer Weight Environmental Assessment Trial (SWEAT) - Healthy Eating Active Living Mapping Attributes using Participatory Photographic Surveys (HEAL MAPPS): A Qualitative Approach to Understanding Unhealthy Weight Gain during Summer Months in Underserved Children

Background: During the summer months, children from underserved homes are at risk for unhealthy weight gain. Little is known about the contributing food and physical activity environment factors. Objective: The objective of this study was to determine the neighborhood-level environmental barriers and facilitators to healthy food and active living during summer break among children living in low-income, urban, neighborhoods. Methods: This study is a part of a larger, multi-state, prospective observational research study, Project SWEAT, which aims to evaluate the behavioral and environmental determinants of unhealthy weight gain during the summer months in underserved elementary aged children. Students in grades pre-k through 5th attending two Columbus City elementary schools located in low-income, urban neighborhoods already participating in Project SWEAT were invited to participate in the HEAL MAPPS study. The Healthy Eating Active Living Mapping Attributes using Participatory Photographic Surveys (HEAL MAPPS) protocol, which engages participants by using their smartphone-like device to identify facilitators and barriers to healthy living through images and mapping software, was utilized. The HEAL MAPPS protocol was adapted for Project SWEAT to include four contacts: 1) orientation to project and equipment training; 2) individual interview discussing images and routes taken; 3) focus group per school site discussing common experiences with neighbors/fellow MAPPers; and 4) local community stakeholder meeting to present images/findings and develop community action plan for each respective community. Results: Nine families enrolled, mapped routes within the neighborhoods of their respective schools and participated in the individual interviews (Contact 2); six of these families participated in focus groups (Contact 3). Children across both sites perceived their food and physical activity environments to have less barriers than their caregivers (overall food: p<0.01, overall physical activity: p<0.01, school 1 food: p<0.01, school 2 physical activity: p<0.01, school 2 food: p=0.17, school 2 physical activity: p<0.01). Perceptions by caregivers and children of food and physical activity environment barriers differed among the two school sites (caregiver food: p<0.01, caregiver physical activity: p=0.81, child food: p=0.73, child physical activity: p