Get access

Midlife and Older Rural Women's Adherence to U.S. Dietary Guidelines Across Stages of Change in Healthy Eating


  • Carol Pullen Ed.D., R.N.,

  • Susan Noble Walker Ed.D., R.N., FAAN

Carol Pullen is Associate Professor and Assistant Dean for Rural Nursing Education, and Susan Noble Walker is Professor and Chair, Department of Gerontological, Psychosocial, and Community Health Nursing, University of Nebraska Medical Center, College of Nursing, Omaha Nebraska.
 Address correspondence to Carol Pullen, University of Nebraska Medical Center, College of Nursing, 985330 Nebraska Medical Center, Omaha, NE 68198–5330. E-mail:


Poor diet is one of the factors that influences morbidity and premature mortality among older women. The purpose of this descriptive correlational study was to assess (a) healthy eating behaviors of midlife and older rural women, as reflected by adherence to the Dietary Guidelines for Americans, and (b) differences in daily servings in each food group consumed by the women across stages of readiness for change in healthy eating. A sample of 371 midlife and older rural women attending a national meeting of a community education organization completed a questionnaire, including items to measure healthy eating and readiness for change in healthy eating. Only 5.9% of the women adhered to all levels of the Food Pyramid. Adherence to individual levels ranged from 3.5% for grain products to 65.4% for fruit. Analyses of variance revealed significant differences (p < 0.05) in servings consumed daily across stages of change for grain (F=4.80), fruits (F=19.02), vegetables (F=9.24), dairy (F=2.45), and meats (F=1.98). Findings suggest the need for community health nurses to design dietary interventions tailored for women's stage of readiness for change to reduce disability in this vulnerable population.