Health programs in faith-based organizations: are they effective?

Faith-Health Collaboration in the United States: Results from a Nationally Representative Study

Purpose.

Estimate the prevalence of and identify characteristics associated with religious congregations' collaboration with health agencies.

Design.

Cross-sectional analyses of self-report data from the National Congregations Study, a random sample of religious congregations generated from the 1998 General Social Survey.

Setting.

United States.

Subjects.

Key informants from 1236 congregations. Each respondent described a single congregation.

Measures.

Respondents provided open-ended descriptions of congregational programs. Researchers coded program descriptions by content (e.g., domestic violence) and whether the program involved collaboration with a secular agency. Other congregational characteristics (e.g., denomination) were measured by validated measures and linked census tract data.

Results.

Overall, 11.1% of congregations participated in faith-health collaboration (FHC). Logistic regression analyses found that FHC was more common among congregations with more members, with a small proportion of congregants under 35 years, and with a senior pastor with a graduate degree. Other effects were conditional; for instance, denominational differences varied depending on urban/suburban/rural location and the proportion of low-income members.

Conclusion.

This study provides the first national estimates of the prevalence of FHC. Such collaborative efforts may require different approaches in different areas. These results can help practitioners identify congregations that may be more willing to collaborate.

Evaluation findings from the Institute for Public Health and Faith Collaborations

OBJECTIVE

The Institute for Public Health and Faith Collaborations sought to cultivate boundary leadership to strengthen collaboration across religious and health sectors to address health disparities. This article presents findings from an evaluation of the Institute and its impact on participating teams of faith and public health leaders.

METHODS

. Self-administered surveys were completed by participating team members (n = 243) immediately post-Institute. Semistructured telephone interviews were conducted with at least one health and one faith leader per team six to eight months after the Institute.

RESULTS

Significant self-reported improvement occurred for all short-term outcomes assessed, with the largest increases in describing organizational frames and why they are important for community change, and understanding the role of boundary leaders in community systems change. Six months after the Institute, participants spoke of inspiration, team building, and understanding their own leadership strengths as important outcomes. Leadership growth centered on functioning in groups, making a change in their work, a renewed faith in self, and a renewed focus on applying themselves to faith/health work. Top team accomplishments included planning or implementing a program or event, or solidifying or sustaining a collaborative structure. The majority felt they were moving in the right direction to reduce health disparities, but had not yet made an impact.

CONCLUSIONS

Results suggest the Institute played a role in helping to align faith and health assets in many of the participating teams.

A sustainability assessment of a health equity fund initiative in Cambodia

All but one of the health equity funds (HEFs) currently operating in Cambodia, introduced to address the adverse effects of low user fee exemption rates, rely heavily on external funding and have high administrative overheads. This article reports on a study of one type of HEF, based in Kirivong Operational Health District (KOD) and operated through local pagoda structures, which demonstrates minimal reliance on external funding and low administrative overheads. We utilize an adapted sustainability assessment framework to assess the ability of pagoda structures to enable financial access for the poorest to public sector health services. We further analyse the strengths and limitations of the pagoda-managed equity fund initiative, with a view to assessing not only its sustainability but its potential for replication in other settings.Our study shows that, against key sustainability indicators (health service utilization and health outcomes; management capacity and financial viability; community mobilization and government support), the pagoda-managed equity fund initiative scores well. However, it is evident that some external financial support is needed to allow the HEFs to function effectively. We conclude with recommendations for replicating the initiative, which include working innovatively with indigenous grassroots organizations to enhance community HEF ownership and to keep administrative overheads low.

Church-based health promotion interventions: evidence and lessons learned

Church-based health promotion (CBHP) interventions can reach broad populations and have great potential for reducing health disparities. From a socioecological perspective, churches and other religious organizations can influence members' behaviors at multiple levels of change. Formative research is essential to determine appropriate strategies and messages for diverse groups and denominations. A collaborative partnership approach utilizing principles of community-based participatory research, and involving churches in program design and delivery, is essential for recruitment, participation, and sustainability. For African Americans, health interventions that incorporate spiritual and cultural contextualization have been effective. Evidence indicates that CBHP programs have produced significant impacts on a variety of health behaviors. Key elements of CBHP are described with illustrations from the authors' research projects.

Using the RE-AIM framework to evaluate a physical activity intervention in churches

INTRODUCTION

Health-e-AME was a 3-year intervention designed to promote physical activity at African Methodist Episcopal churches across South Carolina. It is based on a community-participation model designed to disseminate interventions through trained volunteer health directors.

METHODS

We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate this intervention through interviews with 50 health directors.

RESULTS

Eighty percent of the churches that had a health director trained during the first year of the intervention and 52% of churches that had a health director trained during the second year adopted at least one component of the intervention. Lack of motivation or commitment from the congregation was the most common barrier to adoption. Intervention activities reached middle-aged women mainly. The intervention was moderately well implemented, and adherence to its principles was adequate. Maintenance analyses showed that individual participants in the intervention's physical activity components continued their participation as long as the church offered them, but churches had difficulties continuing to offer physical activity sessions. The effectiveness analysis showed that the intervention produced promising, but not significant, trends in levels of physical activity.

CONCLUSION

Our use of the RE-AIM framework to evaluate this intervention serves as a model for a comprehensive evaluation of the health effects of community programs to promote health.

Church-based breast cancer screening education: impact of two approaches on Latinas enrolled in public and private health insurance plans

INTRODUCTION

The Tepeyac Project is a church-based health promotion project that was conducted from 1999 through 2005 to increase breast cancer screening rates among Latinas in Colorado. Previous reports evaluated the project among Medicare and Medicaid enrollees in the state. In this report, we evaluate the program among enrollees in the state's five major insurance plans.

METHODS

We compared the Tepeyac Project's two interventions: the Printed Intervention and the Promotora Intervention. In the first, we mailed culturally tailored education packages to 209 Colorado Catholic churches for their use. In the second, promotoras (peer counselors) in four Catholic churches delivered breast-health education messages personally. We compared biennial mammogram claims from the five insurance plans in the analysis at baseline (1998-1999) and during follow-up (2000-2001) for Latinas who had received the interventions. We used generalized estimating equations (GEE) analysis to adjust rates for confounders.

RESULTS

The mammogram rate for Latinas in the Printed Intervention remained the same from baseline to follow-up (58% [2979/5130] vs 58% [3338/5708]). In the Promotora Intervention, the rate was 59% (316/536) at baseline and 61% (359/590) at follow-up. Rates increased modestly over time and varied widely by insurance type. After adjusting for age, income, urban versus rural location, disability, and insurance type, we found that women exposed to the Promotora Intervention had a significantly higher increase in biennial mammograms than did women exposed to the Printed Intervention (GEE parameter estimate = .24 [+/-.11], P = .03).

CONCLUSION

For insured Latinas, personally delivering church-based education through peer counselors appears to be a better breast-health promotion method than mailing printed educational materials to churches.

Urban as a determinant of health

Cities are the predominant mode of living, and the growth in cities is related to the expansion of areas that have concentrated disadvantage. The foreseeable trend is for rising inequities across a wide range of social and health dimensions. Although qualitatively different, this trend exists in both the developed and developing worlds. Improving the health of people in slums will require new analytic frameworks. The social-determinants approach emphasizes the role of factors that operate at multiple levels, including global, national, municipal, and neighborhood levels, in shaping health. This approach suggests that improving living conditions in such arenas as housing, employment, education, equality, quality of living environment, social support, and health services is central to improving the health of urban populations. While social determinant and multilevel perspectives are not uniquely urban, they are transformed when viewed through the characteristics of cities such as size, density, diversity, and complexity. Ameliorating the immediate living conditions in the cities in which people live offers the greatest promise for reducing morbidity, mortality, and disparities in health and for improving quality of life and well being.

Congregational health ministries: a national study of pastors' views

OBJECTIVES

Since the 1980s, there has been a growing, but little studied, movement that organizes church-based health services under the direction of a coordinator, usually a registered nurse. These Congregational Health Ministries (CHMs) emphasize health promotion and disease prevention. We compared the perceptions of pastors with and without organized CHMs and the characteristics of their congregations' health ministries.

DESIGN

We used a quantitative, cross-sectional survey design.

SAMPLE

We surveyed a national multidenominational sample of 349 pastors representing over 80 Christian denominations.

RESULTS

With limited resources, CHMs provide significant health promotion, disease prevention, and support services. Pastors with CHMs were significantly more involved in health promotion and disease prevention activities. Pastors without CHMs perceived a need for congregations to be involved in health-related services and were willing to become involved if they have adequate resources.

CONCLUSIONS

Because of long-term trusting relationships that exist between congregants and those who minister to them, religious congregations may be ideally suited to provide cost-effective, community-based health promotion and disease prevention services as well as health-supporting services to community-dwelling elderly and persons with chronic illnesses.

Disaster planning and risk communication with vulnerable communities: lessons from Hurricane Katrina

OBJECTIVES

We studied the experience of Hurricane Katrina evacuees to better understand factors influencing evacuation decisions in impoverished, mainly minority communities that were most severely affected by the disaster.

METHODS

We performed qualitative interviews with 58 randomly selected evacuees living in Houston's major evacuation centers from September 9 to 12, 2005. Transcripts were content analyzed using grounded theory methodology.

RESULTS

Participants were mainly African American, had low incomes, and were from New Orleans. Participants' strong ties to extended family, friends, and community groups influenced other factors affecting evacuation, including transportation, access to shelter, and perception of evacuation messages. These social connections cut both ways, which facilitated and hindered evacuation decisions.

CONCLUSIONS

Effective disaster plans must account for the specific obstacles encountered by vulnerable and minority communities. Removing the more apparent obstacles of shelter and transportation will likely be insufficient for improving disaster plans for impoverished, minority communities. The important influence of extended families and social networks demand better community-based communication and preparation strategies.

Increasing physical activity among church members: community-based participatory research

BACKGROUND

Faith-based interventions using a community-based participatory approach hold promise for eliminating ethnic health disparities. This study evaluated the effects of a volunteer-led statewide program to increase physical activity among members of African-American churches.

METHODS

African Methodist Episcopal churches within six regions (Conferences) were randomly assigned to receive training in the program immediately or 1 year later. A cohort of 20 randomly selected churches and 571 members within them took part in telephone surveys at baseline (May-September 2003) and 1 year (May-August 2004) and 2 years later (June-September 2005). Primary outcomes were physical activity participation, meeting physical activity recommendations, and stage of readiness for physical activity change. Statistical analyses were completed in April 2006.

RESULTS

Volunteers (N=889) from 303 churches were trained. Among survey respondents, physical activity did not increase significantly over time, although 67% were aware of the program. Program awareness was significantly related to all three physical activity outcomes and to fruit and vegetable consumption. Pastoral support was significantly associated with physical activity.

CONCLUSIONS

Although this intervention reached a large number of churches and created awareness of intervention components, no effects on physical activity behaviors were found. Potential reasons for the lack of significant effects are discussed.

The WORD (wholeness, oneness, righteousness, deliverance): a faith-based weight-loss program utilizing a community-based participatory research approach

Despite multidisciplinary efforts to control the nation's obesity epidemic, obesity has persisted as one of the U.S.'s top public health problems, particularly among African Americans. Innovative approaches to address obesity that are sensitive to the unique issues of African Americans are needed. Thus, a faith-based weight-loss intervention using a community-based participatory research approach was developed, implemented, and evaluated with a rural African American faith community. A two-group, quasi-experimental, delayed intervention design was used, with church as the unit of assignment (treatment n=2, control n=2) and individual as the unit of observation (treatment n=36, control n=37). Weekly small groups led by trained community members met for 8 weeks and emphasized healthy nutrition, physical activity, and faith's connection with health. The mean weight loss of the treatment group was 3.60+/-0.64 lbs. compared to the 0.59+/-0.59-lb loss of the control group.

Assessment of the relationship between neighborhood characteristics and dental caries severity among low-income African-Americans: a multilevel approach

OBJECTIVES

To assess the relationship between neighborhood effects and the severity of dental caries among low-income African-Americans.

METHODS

A multistage probability sample of African-American families living in the poorest 39 census tracts in Detroit was drawn. During 2002-03, cross-sectional data of a cohort that includes 1021 caregivers were collected in the first of three waves of interviews and examinations. Multilevel analyses focused on 27 neighborhood clusters and involved a combination of individual (Level-1) and neighborhood (Level-2) data including census and geocoded (address matching to census geographic areas) information.

RESULTS

There is significant variation in the severity of caries between low-income neighborhood clusters. Caries severity decreases with a higher number of churches, while it increases with a higher number of grocery stores in the clusters after accounting for individual characteristics. Only 14% of the inter-individual variability in caries was explained by classical individual risk factors for this condition.

CONCLUSION

Neighborhoods contribute something unique to caregivers' oral health, beyond socioeconomic position and individual risk factors. Multilevel interventions are necessary to reduce disparities among African-Americans and churches may offer a promising venue from which to conduct them.

Public and private domains of religiosity and adolescent smoking transitions

We used data from a nationally representative sample of US adolescents in school grades 7 through 12 to explore the effects of public and private religiosity on initiation, escalation, and cessation of smoking. We found that adolescents' decisions to experiment with smoking are influenced by both their individual practice of their faith and by participation in a larger faith community. However, the effects of private and public religiosity are specific to different decision points on the smoking uptake process. Private religiosity was protective against initiation of regular smoking among nonsmokers. It also was protective against initiation of experimental smoking but only when the young person frequently attended religious services or a religious youth group. Although private religiosity appeared to discourage the uptake of smoking, it was unrelated to reduction or cessation once a young person has become addicted to cigarettes. In contrast, public religiosity did predict reduction and cessation of cigarette use among regular smokers. Taken together, these findings demonstrate that the domains in which religiosity are important extend beyond the individual and include religious institutions.