Leading God's People: Perceptions of Influence Among African-American Pastors

High Rates of Obesity and Chronic Diseases Among North Carolina United Methodist Clergy: An Updated Analysis

Background

Varied demands and stressors experienced by clergy can contribute adversely to their overall well-being. Data from United Methodist Church (UMC) clergy in North Carolina in 2008 revealed that clergy had significantly higher non-communicable disease (NCD) rates than their fellow North Carolinians.

Methods

Using data from the Clergy Health Initiative and Behavioral Risk Factor Surveillance Survey, the present study provided an updated analysis of obesity and 6 other NCDs among North Carolina UMC clergy compared to the general North Carolina population. First, we described the prevalence of each health condition among North Carolina UMC clergy and the general North Carolina population across multiple waves from 2008 to 2021. Then, we compared the predicted probabilities of each health condition in 2021 using logistic regressions to adjust for age, sex, and race.

Results

Comparing the unadjusted prevalence of health conditions between 2008 and 2021, we found that North Carolina UMC clergy have higher rates of obesity, hypertension, hypercholesterolemia, diabetes, angina, arthritis, and asthma than North Carolinians overall. Adjusting for age, sex, and race, we found that significantly higher rates of obesity, severe obesity, hypercholesterolemia, and asthma persisted among UMC clergy in 2021 compared to all North Carolinians, with the higher rates of severe obesity being particularly concerning.

Limitations

While the current study is limited to an update of health prevalence among UMC clergy, pastors across denominations are influential leaders in their communities, shaping the physical and social health environments of their congregations.

Conclusions

Further research is needed to investigate risk factors, such as relocation and adverse childhood experiences, which may influence the higher prevalence of NCDs within and potentially beyond the UMC.

Black Pastors' Experiences of Occupational and Life Stress During COVID-19 in the USA

This study sought to identify the occupational stressors Black pastors experience, who serve in Black Church denominations and Black nondenominational churches. A total of 218 pastors completed the survey out of 2786 for a response rate of 10.1%. Black pastors identified their most challenging stressors as member dynamics, financial stress, leading a church to fulfill its mission, and pastor's workload. Black women pastors faced the additional stressor of having their pastoral leadership challenged by male congregants. Black pastors faced more stressors during the COVID-19 pandemic including church closures, transitioning to virtual services, unexpected deaths, and an increased workload with 72.5% of pastors reporting moderate to extreme stress levels. Approximately 77% of pastors acknowledged experiencing from moderate to extreme stress levels during social protests for the deaths of Black people by law enforcement. Black pastors further acknowledged experiencing an additional three to six life stressors outside of their pastoral roles.

An Examination of Culturally Relevant Health Messages in African-American Churches

This quantitative study examined the presence of culturally relevant health messages for African-Americans based on a preexisting dataset from 21 African-American churches in South Carolina (USA). Content analysis served as the primary methodological approach to code printed media messages based on their cultural relevance among African-Americans (Cohen's kappa = .74). Within the dataset (n = 2166), 477 (22%) items were identified as culturally relevant. A low prevalence of culturally relevant messages was found across the three message topics, two media types, and one media source. Due to the limited presence of culturally relevant messages, researchers should collaborate with African-American churches to design health promotion messages.

Fit with Faith: An Exploratory Study Examining a Behavior Change Intervention for African-American Clergy and Their Spouses

Fit with Faith is a 10-week, diet, physical activity, and stress reduction intervention for African-American clergy and spouses, which included: meetings, phone calls, a behavior tracking app. Survey, 24-h recall, accelerometer, anthropometric, and blood pressure data were collected. Wilcoxon signed ranked tests were used for analyses. In this one-arm study, clergy and spouses (n = 20) attended most meetings and calls, but only half posted daily goals or tracked behaviors using the app. Spouses' body mass index (BMI) decreased and physical activity self-regulation cognitive scores increased pre-post intervention. Statistically significant changes in BMI, systolic blood pressure, and self-regulations scores also were seen among younger (< 51 years) participants (n = 8). As positive changes were seen mostly among women and younger participants, more research is needed on how to engage all clergy in behavior change programs.

Faith Community Nurses Key to Promoting Health in At-Risk Communities: An Integrative Review

ABSTRACT

An integrative literature review was conducted to identify recommendations to implement culturally congruent and spiritually connected approaches to health promotion in at-risk faith communities. Five themes emerged from an analysis of 48 articles meeting criteria for the review. Review results repeatedly highlighted the impact nurses-more specifically faith community nurses (FCNs)-can have on at-risk population outcomes and bridging the gap between minority communities and the healthcare establishment. Five recommended action steps provide program guidance to FCNs for promoting faith-based health in at-risk minority communities.

Congregational health needs by key demographic variables: Findings from a congregational health needs assessment tool

Health needs assessments identify important issues to be addressed and assist organizations in prioritizing resources. Using data from the Mid-South Congregational Health Survey, top health needs (physical, mental, social determinants of health) were identified, and differences in needs by key demographic variables (age, sex, race/ethnicity, education) were examined. Church leaders and members (N = 828) from 92 churches reported anxiety/depression (65 %), hypertension/stroke (65 %), stress (62 %), affordable healthcare (60 %), and overweight/obesity (58 %) as the top health needs in their congregations. Compared to individuals < 55 years old and with a college degree, individuals ≥ 55 years old (ORrange=1.50-1.86) and with ≤ high school degree (ORrange=1.55-1.91) were more likely to report mental health needs (anxiety/depression; stress). African Americans were less likely to report physical health needs (hypertension/stroke; overweight/obesity) than individuals categorized as Another race/ethnicity (ORrange=0.38-0.60). Individuals with ≤ high school degree were more likely to report affordable healthcare as a need compared to individuals with some college or a college degree (ORrange=1.58). This research highlights the need for evaluators and planners to design programs that are comprehensive in their approach to addressing the health needs of congregations while also considering demographic variation that may impact program participation and engagement.

Depression in the African American Christian Community: Examining Denominational and Gender Differences

Depression among African American adults can diminish their daily functioning and quality of life. African American communities commonly uses religion and spirituality (R/S) to cope with life stressors; however, it is unclear whether R/S contribute to mental health risk or resilience. Since men and women differ in their R/S participation and Christian denominations have varying gender roles and expectations, it is critical to determine if they experience similar mental health effects. This study examines whether self-reported denominational affiliation predicts dissimilar odds of reporting elevated depressive symptoms among African American young adults and if these effects are different for women and men, using the National Longitudinal Study of Adolescent to Adult Health (Add Health). Results indicate that the odds of having elevated depressive symptoms are three times higher for Catholic women compared to Baptist women, but no denominational differences were found among men. This study highlights how unique denominational and gender subcultures within African American Christian communities may predict depression outcomes. Healthcare professionals and church-based outreach programs should consider the role of denomination and gender when designing and participating in efforts to support mental health equity.

The Role of Black Pastors in Disseminating COVID-19 Vaccination Information to Black Communities in South Carolina

COVID-19 vaccination rates have increased since distribution began in December 2020. However, in some states, such as South Carolina, getting people to take the vaccine has been challenging; as of spring 2022, slightly less than 60% of the total population is fully vaccinated. Vaccine hesitancy among Black Americans may be explained by several factors, including lack of confidence in the medical establishment and vaccines in particular. Faith-based leaders, such as pastors, can make a difference. This study explores the communication strategies that pastors in predominantly Black churches use to increase COVID-19 vaccination rates among churchgoers and the surrounding community. We conducted semi-structured interviews with 10 pastors in South Carolina. The main themes that emerged are: (1) using various communication channels to ensure access; (2) representing a trusted source of information; (3) offering a role model for vaccination—leading by example; and (4) strengthening the commitment to health. As the need for COVID-19 vaccination continues, including booster vaccines, pastors can provide accurate information and community outreach to promote the health of Black communities.

Engaging African American Pastors in COVID-19 Research During a Pandemic: Lessons Learned

African American pastors are recognized as trusted information sources for their communities. The pastors willing to address health-related concerns such as preventing the spread of the coronavirus are invaluable for leading their congregation through relevant health programs. Underlining the importance of religion, spirituality, and faith-based leaders in addressing and furthering health promotion research, the article discusses lessons learned during the study implementation and the recommendations for engaging minority pastors in research during a global health pandemic.

Overcoming Historical Barriers: Enhancing Positive Perceptions of Medical Research Among African Americans Through a Conference-Based Workshop

BACKGROUND

African Americans (AAs) and other racial/ethnic minority groups continue to be underrepresented in medical research and clinical trials. Failure to create more racially diverse research cohorts can exacerbate existing health disparities among these groups.

OBJECTIVE

To investigate best practices and strategies for enhancing participation of AAs in medical research among attendees of a preconference Institute at a faith-based public health conference.

DESIGN

Qualitative study using semi-structured interviews.

PARTICIPANTS

A total of 21 out of 29 attendees (90% AA) of the Institute (72% response rate).

APPROACH

A culturally tailored preconference Institute was held at the 2017 Healthy Churches 2020 National Conference. The Institute was led by AA researchers focused on underrepresentation of AAs in medical research. Semi-structured interviews were conducted 1-year post-Institute (n=21) and were audio-recorded, transcribed verbatim, and reviewed using thematic analysis.

KEY RESULTS

The majority of attendees reported that they were more likely to participate in medical research after attending the Institute (75%). Salient learning points reported by attendees demonstrated attainment of the Institute objectives. Key themes emerged describing barriers preventing AAs from participating in medical research including fear/lack of trust, lack of information on research projects, and not being approached to participate. Key themes regarding facilitators for participation in medical research by AAs were clear communication of study objectives and research benefits along with trust in researchers.

CONCLUSIONS

Attendees' perceptions of participation in medical research were largely positive following their attendance at a conference-based Institute aimed to address the underrepresentation of AAs in medical research. Our culturally tailored approach to disseminating knowledge of the research process could extend to other national conferences prioritizing AAs and other racial/ethnic minority populations to improve research participation.

"A Charge to Keep I Have": Black Pastors' Perceptions of Their Influence on Health Behaviors and Outcomes in Their Churches and Communities

The Black church has become a necessary refuge and haven for hope in turbulent times in the USA. In recent years, the Black pastors' role has evolved into the position of a leading figure in addressing health disparities in the church and community. Therefore, the purpose of this qualitative study was to gain a more extensive understanding of Black pastors' perceptions of their influence on health behaviors and outcomes in their churches and communities. Due to limited research in this area, a phenomenological qualitative paradigm was used to add to future research. In-depth, semi-structured interviews were conducted with 12 Black pastors. Four themes emerged: Pastoral Self-Reflection of Health; Misperception of Health Awareness from Congregants; Pastoral Leadership that Encourages Health Promotion; and the Importance of Community Resources and Health Programs. Overall, pastors viewed health as a holistic approach and included the importance of spirituality in their perspectives. According to pastors, there are suggestions for more access to resources, community partnerships, and education to address the lack of participation among black congregants.

A Multilevel Diabetes and CVD Risk Reduction Intervention in African American Churches: Project Faith Influencing Transformation (FIT) Feasibility and Outcomes

Wide-reaching health promotion interventions are needed in influential, accessible community settings to address African American (AA) diabetes and CVD disparities. Most AAs are overweight/obese, which is a primary clinical risk factor for diabetes/CVD. Using a faith-community-engaged approach, this study examined feasibility and outcomes of Project Faith Influencing Transformation (FIT), a diabetes/CVD screening, prevention, and linkage to care pilot intervention to increase weight loss in AA church-populations at 8 months. Six churches were matched and randomized to multilevel FIT intervention or standard education control arms. Key multilevel religiously tailored FIT intervention components included: (a) individual self-help materials (e.g., risk checklists, pledge cards); (b) YMCA-facilitated weekly group Diabetes Prevention Program (DPP) weight loss classes; (c) church service activities (e.g., sermons, responsive readings); and (d) church-community text/voice messages to promote healthy eating and physical activity. Health screenings (e.g., weight, blood pressure, blood glucose) were held during church services to identify participants with diabetes/CVD risks and refer them to their church's DPP class and linkage to care services. Participants (N = 352 church members and community members using churches' outreach ministries) were primarily female (67%) and overweight/obese (87%). Overall, FIT intervention participants were significantly more likely to achieve a > 5 lb weight loss (OR = 1.6; CI = 1.24, 2.01) than controls. Odds of intervention FIT-DPP participants achieving a > 5 lb weight loss were 3.6 times more than controls (p < .07). Exposure to sermons, text/email messages, brochures, commitment cards, and posters was significantly related to > 5 lb. weight loss. AA churches can feasibly assist in increasing reach and impact of diabetes/CVD risk reduction interventions with intensive weight loss components among at risk AA church-populations.

Identifying barriers, facilitators, and implementation strategies for a faith-based physical activity program

Background

Community engagement is critical to the acceleration of evidence-based interventions into community settings. Harnessing the knowledge and opinions of community leaders increases the likelihood of successful implementation, scale-up, and sustainment of evidence-based interventions. Faith in Action (Fe en Acción) is an evidence-based promotora-led physical activity program designed to increase moderate-to-vigorous physical activity among churchgoing Latina women.

Methods

We conducted in-depth interviews using a semi-structured interview guide based on the Consolidated Framework for Implementation Research (CFIR) at various Catholic and Protestant churches with large Latino membership in San Diego County, California to explore barriers and facilitators to implementation of Faith in Action and identify promising implementation strategies for program scale-up and dissemination. We interviewed 22 pastors and church staff and analyzed transcripts using an iterative-deductive team approach.

Results

Pastors and church staff described barriers and facilitators to implementation within three domains of CFIR: characteristics of individuals (lack of self-efficacy for and knowledge of physical activity; influence on churchgoers' behaviors), inner setting (church culture and norms, alignment with mission and values, competing priorities, lack of resources), and outer setting (need for buy-in from senior leadership). From the interviews, we identified four promising implementation strategies for the scale-up of faith-based health promotion programs: (1) health behavior change training for pastors and staff, (2) tailored messaging, (3) developing community collaborations, and (4) gaining denominational support.

Conclusions

While churches can serve as valuable partners in health promotion, specific barriers and facilitators to implementation must be recognized and understood. Addressing these barriers through targeted implementation strategies at the adopter and organizational level can facilitate improved program implementation and lead the way for scale-up and dissemination.