A multi-level approach for promoting HIV testing within African American church settings

Qualitative Inquiry of African American Female Church Leaders on Facilitators and Barriers of Conducting Adult Health Programs Within African American Churches: A Pilot Study Using a Socioecological Perspective Within the United States

Despite the success of health programs conducted within African American (AA) churches, research has been limited in understanding the facilitators and barriers of conducting adult health programs in churches led by female AA pastors/leaders. In addition, research has yet to analyze the effect of policy on these church-based health programs. Thus, this pilot study's objective is to use the socio-ecological model (SEM) as a framework to explore female AA pastors' and church leaders' perspectives, in the U.S., on facilitators and barriers that exist when conducting adult health programs within their congregations. Using snowball sampling to recruit AA female church leaders and pastors (n = 6), semi-structured interviews were conducted with study participants. Data were then transcribed and analyzed using First and Second Cycle coding to identify themes. Nine themes emerged from the data, and after stratifying the themes according to the SEM, this study found that facilitators and barriers exist at the intrapersonal, organizational, community, and policy levels of the SEM. It is important for these factors to be considered to ensure that health programs led by AA women pastors/leaders are successful within AA churches. Study limitations and the need for further research are also noted.

Facilitators and Barriers When Conducting Adult Health Programs Within the African American Church: A Systematic Review

Despite the success of health programs conducted within African American (AA) churches, research has been limited in understanding facilitators and barriers that exist when conducting adult health programs within AA churches. Thus, the objective of this study was to systematically review the literature to identify these facilitators and barriers. A comprehensive literature search was conducted and studies that met the eligibility criteria were divided based on their focus: disease topic or behavior, health promotion activities, or church readiness. Facilitators and barriers were also stratified using the socioecological model. Out of 288 articles initially identified, only 29 were included. Facilitators and barriers were predominantly found at the intrapersonal and organizational level for disease topic or behavior studies, and at the organizational level for studies focused on health promotion activities and church readiness. None of the articles identified facilitators and barriers at the policy level.

Deterrents and motivators of HIV testing among young Black men who have sex with men in North Carolina

In the United States (US), young, Black men who have sex with men (YBMSM) are disproportionately affected by HIV. Delayed and infrequent HIV testing has been associated with the increased likelihood of YBMSM to be infected, yet unaware. Despite increased efforts to provide HIV testing to YBMSM in the US, HIV testing remains underutilized by YBMSM in the South. To develop strategies to increase HIV testing, this study sought to understand the factors that affect HIV testing utilization among YBMSM. Twenty-two HIV-positive and HIV-negative YBMSM aged 22-33 in North Carolina participated in semistructured interviews. Qualitative thematic analysis revealed that deterrents and motivators to HIV testing spanned individual, social, and structural levels. Deterrents included a low perceived risk of HIV, fear of receiving an HIV-positive test result, lack of HIV testing locations, healthcare provider mistreatment and privacy concerns due to intersectional stigma. Motivators of HIV testing included health maintenance, social support, and increased access to HIV testing. The findings from this study contribute to ongoing research that aims to address inconsistent HIV testing and late HIV diagnosis among YBMSM. Interventions to address intersectional stigma in community and healthcare settings can enhance utilization of HIV prevention services .

Implementation of HIV Interventions Into Faith-Based Organizations: Models and Methodological Considerations

BACKGROUND

Implementation of evidence-based interventions aimed at reducing and treating HIV can have a wider spread if funneled through faith-based organizations. However, there is a paucity of frameworks or process models aimed at providing the best practices to implement HIV interventions into faith-based community organizations.

SETTING

Implementation framework and process model for African American faith settings.

RESULTS

Presented here is a systems multilevel implementation framework and implementation process model for integrating HIV interventions into faith-based organizations. We conclude with presentation of key methodological considerations and recommendations and discuss strategies for moving implementation science forward in faith-based organizations.

CONCLUSION

Because of their key role in the African American community, faith-based settings must be engaged in implementing evidence-based HIV interventions. Through use of a multilevel systems framework and process model, the methods and approaches of implementation science can be leveraged to encourage the spread of HIV interventions in the African American community.

Rigor in Qualitative Methods: An Evaluation of Strategies Among Underrepresented Rural Communities

Achieving rigor using selected criteria to determine trustworthiness using qualitative methods has been without critical evaluation. In this article, strategies such as prolonged engagement and thick, rich description; negative case analysis; peer review or briefing; clarifying researcher bias; member checking; and, investigator triangulation and intercoder reliability are evaluated for appropriateness among an African American Appalachian rural population. Achieving rigor using qualitative methods among participants living in rural communities is time intensive requiring attention to quality versus quantity of time spent in interviews, building trusting relationships, an awareness of interviewer bias and assumptions, and appropriately evaluated strategies that enhance validity. Strategies to achieve rigor in qualitative methods should not be used as a one size fits all approach as this practice might actually diminish rigor. Among underrepresented populations, strategies should be adapted or not used at all.

Congregational involvement in HIV: A qualitative comparative analysis of factors influencing HIV activity among diverse urban congregations

Religious congregations can potentially reach disproportionately affected populations with HIV programming, however, factors that influence congregational involvement in HIV are not well-studied. Utilizing comparative case methods and in-depth qualitative data from a diverse sample of 14 urban congregations, we examine a range of attitudinal, organizational, resource, and demographic factors to systematically identify different case scenarios-i.e., combinations of characteristics-associated with the level and types of HIV activities in which the congregational cases tended to be involved. For example, White or mixed race congregations with active gay constituencies and an African-American congregation with a strong lay HIV champion were among the high HIV involvement case scenarios, compared to African-American congregations with a health emphasis but no lay HIV champion among the medium HIV involvement scenarios, and fundamentalist African-American and Latino congregations among the low HIV involvement scenarios. Two key factors that appeared influential across case scenarios included the existence of lay champions for HIV activities and the general theological orientation of the congregation.

Rural Black Pastors: the Influence of Attitudes on the Development of HIV/AIDS Programs

This exploratory research addressed the question, among rural Mississippi African American Baptist pastors, what is the impact of attitudes toward HIV/AIDS on the development of HIV/AIDS programs in the church? It was hypothesized that empathetic attitudes toward HIV make programming more likely. The study used Froman and Owen's AIDS Attitude Scale (AAS) and a demographic questionnaire, which included a measure that assessed potential program development. A sample of more than 300 African American pastors participated. The findings suggested that there is a significant relationship between rural Mississippi African American Baptist pastors' empathetic attitudes toward AIDS and their willingness to develop an HIV/AIDS program.

Promoting Health from the Pulpit: A Process Evaluation of HIV Sermons to Reduce HIV Stigma and Promote Testing in African American and Latino Churches

Embedding health messages into sermons is a potentially valuable strategy to address HIV and other health disparities in churches that predominantly serve racial and ethnic minorities. This study explores implementation of an HIV sermon as part of a multi-component intervention in three churches (Latino Catholic, Latino Pentecostal, and African American Baptist) in high HIV prevalence areas of Los Angeles County, California. Clergy were given an HIV sermon guide that included local public health data, stigma reduction cues, HIV testing messages, and a sample sermon. Findings are based on a process evaluation (i.e., reach, dose delivered, fidelity, and implementation) and in-depth content analysis to explore HIV frames and messages used by clergy. Sermons were audio-recorded, transcribed verbatim, and coded using an inductive approach. Complementary data were collected through systematic observation. Overall, five clergy delivered nine HIV sermons to majority African American or Latino audiences. On average, 174 congregants were reached per sermon. We found large variation in fidelity to communicating key HIV messages from the sermon guide. While promoting HIV testing from the pulpit seemed viable and acceptable to all the participating clergy, fewer embedded explicit stigma reduction cues. Most spoke about HIV using compassionate and non-judgmental terms, however, issue framing varied across clergy. Structured training of clergy may be necessary to implement the more theoretically driven stigma reduction cues included in the sermon guide. More research is needed on the viability and acceptability of embedding specific health promotion messages into sermons.

Review of Community Based Organization and Community Pharmacy Partnerships for Preventive Care Services

Collaborative care has been widely recognized as being critical to promoting the health of individuals and populations. It is hypothesized that the development of partnerships between community-based organizations and community pharmacies may result in increased access to preventive care services for community members with the goal of improving health outcomes. The purpose of this review was to identify and describe partnerships between community-based organizations and community pharmacies. A literature search was conducted for all articles in the English language published through January 2018 that included these types of partnerships offering preventive care services. A total of seven articles were included in the review, of which the majority were conducted in the United States (n=5). Community-based organizations included businesses, community health centers, local associations, public health departments, schools, and workplaces. Preventive care services that were offered included blood pressure and cardiovascular risk assessment, diabetes management, flu ready card and HIV self-test kit voucher distribution and education, and bone mineral density screenings. The limited literature suggests that additional opportunities should be explored in order for community-based organizations and community pharmacies to partner in order to provide and evaluate the impact of preventive care services in the community setting.

African American Church Engagement in the HIV Care Continuum

Providing comprehensive services across the HIV care continuum through African American churches may improve HIV treatment outcomes for African Americans. We explored the feasibility of a church-led HIV care program in six churches in Baltimore, Maryland. Church leaders (n = 57) participated in focus groups and eight pastors participated in interviews. Data were analyzed by qualitative hybrid thematic analysis. Findings revealed eight themes: four themes were related to linkage to care: being unaware of community resources, concerns about HIV-associated regulations, ongoing personalized contact with HIV-infected persons, and desire for integration of spiritual education; four themes were related to HIV care and support services, including existing church infrastructure, provision of HIV support groups, using the church as an HIV care resource hub, and prevention education for uninfected people. These findings can support initiatives and efforts to promote delivery of HIV services along the HIV care continuum through African American churches.

Stakeholder conceptualisation of multi-level HIV and AIDS determinants in a Black epicentre

HIV has reached epidemic proportions among African Americans in the USA but certain urban contexts appear to experience a disproportionate disease burden. Geographic information systems mapping in Philadelphia indicates increased HIV incidence and prevalence in predominantly Black census tracts, with major differences across adjacent communities. What factors shape these geographic HIV disparities among Black Philadelphians? This descriptive study was designed to refine and validate a conceptual model developed to better understand multi-level determinants of HIV-related risk among Black Philadelphians. We used an expanded ecological approach to elicit reflective perceptions from administrators, direct service providers and community members about individual, social and structural factors that interact to protect against or increase the risk for acquiring HIV within their community. Gender equity, social capital and positive cultural mores (e.g., monogamy, abstinence) were seen as the main protective factors. Historical negative contributory influences of racial residential segregation, poverty and incarceration were among the most salient risk factors. This study was a critical next step toward initiating theory-based, multi-level community-based HIV prevention initiatives.

Predictors of HIV/AIDS Programming in African American Churches: Implications for HIV Prevention, Testing, and Care

Using data from the National Congregational Study, we examined predictors of having an HIV/AIDS program in predominately African American churches across the United States. We conducted regression analyses of Wave II data ( N = 1,506) isolating the sample to churches with a predominately African American membership. The dependent variable asked whether or not the congregation currently had any program focused on HIV or AIDS. Independent variables included several variables from the individual, organizational, and social levels. Our study revealed that region, clergy age, congregant disclosure of HIV-positive status, permitting cohabiting couples to be members, sponsorship or participation in programs targeted to physical health issues, and having a designated person or committee to address health-focused programs significantly increased the likelihood of African American churches having an HIV/AIDS program. A paucity of nationally representative research focuses on the social-, organizational-, and individual-level predictors of having HIV/AIDS programs in African American churches. Determining the characteristics of churches with HIV/AIDS programming at multiple levels is a critical and necessary approach with significant implications for partnering with African American churches in HIV or AIDS initiatives.