Identifying health conditions, priorities, and relevant multilevel health promotion intervention strategies in African American churches: A faith community health needs assessment

Abstract

African Americans continue to experience a myriad of health disparities, including higher rates of asthma, diabetes, heart disease, stroke, human immunodeficiency virus (HIV), and homicides (Centers for Disease Control and Prevention [CDC], 2013; National Center for Health Statistics [NCHS], 2016). Due to these and other health disparities, African Americans have the shortest life expectancy across all races and ethnicities in the United States (NCHS, 2016). Additionally, many African Americans have limited access to care and a number of barriers, such as lack of insurance, low health literacy, and poor patient provider communication prevent many African Americans from using needed health care services (CDC, 2013; Epping-Jordan, Pruitt, Bengoa, & Wagner, 2004; Heisler, Rust, Pattillo, & Dubois, 2005; NCHS, 2016). Promotion of healthy behaviors across the health care continuum – including prevention, diagnostic, and treatment services, along with improving access to these services is critical to addressing African American health disparities (CDC, 2013; Epping-Jordan, Pruitt, Bengoa, & Wagner et al., 2004). Also, consideration should be given to addressing health disparities with culturally-appropriate community approaches that can promote healthy lifestyles among African Americans. The Black Church is a long-standing institution with many strengths that can be tapped to extend the reach of health promotion interventions in African American communities. National studies indicate that over 50% of African Americans attend church services weekly (Pew Research Center, 2009; 2015), suggesting the tremendous potential to reach a large number of African Americans in church settings. Furthermore, most African American churches: a) are led by pastors who can be highly influential (Davis, Bustamante, Brown, Wolde-Tsadik, Savage et al., 1994; Taylor, Chatters, & Levin, 2004); b) are based on common biblical doctrine and religious activities (Lincoln & Mamiya, 1990); c) emphasize taking care of one’s body, which is seen as the “temple of God” (Taylor, Chatters, Levin, 2004); d) have outreach ministries (e.g., clothing/food programs, social services; Author et al., 2012; Derose, Mendel, Palar, Kanouse, Bluthenthal et al., 2011) that reach community members who may have health risks and limited access to care; e) have infrastructure capacity (e.g., meeting space, membership management systems, volunteers; Author et al., 2012; Campbell, Hudson, Resnicow, Blakeney, Paxton, 2007); and f) have a history of coordinating health-related activities (e.g., Author et al., 2012; Campbell, Hudson, Resnicow, Blakeney, Paxton, 2007; Derose, Mendel, Palar, Kanouse, Bluthenthal et al., 2011). Also, most churches have weekly, multilevel church activities (e.g., ministry groups, Sunday church services, community programs) that could assist in removing barriers and increasing access to health promotion services for underserved African Americans. Given their reach and influence, Black churches could serve an important role in delivering accessible, scalable health promotion interventions to church members and the community members they serve. Past studies demonstrate that the Black Church can be a practical setting for health promotion interventions, including interventions focused on fruit/vegetable consumption, physical activity, weight loss, smoking cessation, and health screenings (e.g., Author et al., 2004; Campbell, Hudson, Resnicow, Blakeney, Paxton et al., 2007; Duan, Fox, Derose, & Carson, 2000; Francis & Liverpool, 2009; Resnicow, Jackson, Blissett, Wang, McCarty et al., 2005; Sattin, Williams, Dias, Garvin, Marion et al., 2015). However, reports on church-based health promotion interventions indicate they often are designed by researchers, address a single health issue, usually include only one or two levels of intervention strategies (e.g., group, church services), rarely include community-level intervention strategies, and have had mixed levels of success. Moreover, most have not addressed access to care or the myriad of other overlapping factors that contribute to health problems (e.g., comorbidities, health literacy, unhealthy environments; e.g., Jackson, Perkins, Khandor, Cordwell, Hamann et al., 2006). Furthermore, limited, comprehensive information is available from African American church-populations on their prioritization of health disparity issues and potential church-community solutions to address these issues. Community Health Needs Assessments Community health needs assessments (HNAs) have been used as a community-engaged process to identify priority health issues with community members experiencing health concerns (Fawcett, Suarez de Balcazar, Whang-Ramos, Seekins, Bradford et al., 1988; Sharma, Lanum, & Suarez-Balcazaar, 2000). HNAs also engage stakeholders who can leverage their influence and resources to address community health issues collaboratively with community members. Additionally, HNAs can help identify barriers, facilitators, and community input on the importance and feasibility of potential multisectoral (e.g., churches, schools, businesses) and multilevel intervention strategies (e.g., individual, group, organization, community) to address health issues. HNA benefits can include early community buy-in and commitment to address health issues, better resource allocation through community partnerships, improved validity of procedures, and improved development of culturally-appropriate health promotion intervention strategies that can positively impact health outcomes (Cottler, McCloskey, Aguilar-Gaxiola, Bennett, Strelnick et al., 2013; Fawcett, Suarez de Balcazar, Whang-Ramos, Seekins, Bradford et al., 1988; Lillie-Blanton & Hoffman, 1995; Sharma, Lanum, & Suarez-Balcazaar, 2000; Wright, Williams, & Wilkinson, 1998). Despite the growing number of African American church-based health promotion studies, to our knowledge only one study has reported on a church health assessment that sought to understand health concerns, conditions, and related behaviors with churchgoers. Whitt-Glover, Porter, Yore, Demons, Goldmon et al. (2014) conducted a church health assessment (N = 887) with participants who were primarily Black (68%) and women (70%). The most prevalent health conditions reported were high blood pressure (40%), diabetes (16%), and asthma (13%). Most participants reported always/most of the time getting regular medical checkups, eating healthy foods, and losing/maintaining their weight. However, this study’s health assessment did not provide comprehensive information on other health disparity conditions that burden African Americans, such as violence, mental health, and HIV/STDs, and related health risks. Also, no participant information was provided on potential church-community intervention strategies to address the identified health conditions; nor was information provided on how the faith community was engaged in the survey development planning process, which is central to the development of HNAs. We report on a faith-based HNA conducted to identify health priorities, health conditions and related screenings and behaviors, and relevant multilevel health promotion intervention strategies to address health disparities in African American churches. We also report on our iterative 12-month HNA planning process that fully engaged African American faith leaders and representatives from other community sectors in: a) reviews/identification of health disparity conditions, b) HNA survey planning, c) church recruitment and survey administration, d) feedback of survey findings, and e) intervention design, and f) launch of a multilevel intervention health promotion intervention in African American churches based on HNA findings.