Using photovoice to explore social determinants of obesity in two underserved communities in the southeast.

Over the past 25 years, the adult obesity rate in the U.S. has increased 70%, with obesity placing a disproportionate chronic disease burden on African Americans. Using Photovoice methodology, this study aimed to: (1) explore the social determinants contributing to obesity from the perspectives of residents of two low-income municipalities in Birmingham, Alabama with varying levels of segregation, (2) better understand residents' perceptions of contributors to obesity in their communities, and (3) examine residents' perceptions of interventions that might be effective in promoting positive change. Focus groups (N=10) segmented by race and community were conducted by trained moderators. Transcriptions were analyzed by theoretical thematic analysis. The study design and data analysis analyses were guided by a conceptual framework based on the Social Determinants of Obesity model. Findings from this study lend support to the efficacy of the conceptual framework as a multilevel approach describing obesity disparities in the south. Regardless of community and race, participants believed that elements of their built environment, such as fast food restaurants and unsafe walking conditions, contributed to obesity, and that schools and churches should play an active role in addressing the issue.