Faith-based Setting Research Articles

Bridging the gap between spirituality and mental health: the need for trauma-informed ministries within Latino communities

ABSTRACT The impact of trauma on mental health has led to the increased development of trauma-informed organizations. Little is known, however, about the benefits of using a trauma-informed care perspective within a faith-based setting, particularly among Latino communities. This article reviews the literature and identifies gaps suggesting the problem of a lack of mental health and trauma-informed awareness among places of worship. The need for developing trauma-informed ministries within places of worship is recommended to assist in promoting the psychological, emotional, and spiritual well-being of congregants and community members within faith-based settings.

Lift Every Voice: Engaging Black Adolescents in Social Justice Service-Learning to Promote Mental Health and Educational Equity

This study reports on the feasibility and acceptability of a social justice infused service-learning (S-L) program to promote Black adolescent mental health and educational equity. We convened a community advisory board to help adapt and pilot test, via open trial mixed method design, an evidence-based service-learning program for Black middle school adolescents (n = 21) attending summer camp at a faith-based setting. We describe a S-L curriculum, with a focus on the achievement gap, and training for church staff and assess staff and youth reports of feasibility, acceptability, and promise to (a) improve/engage psychological engagement targets, and (b) improve academic motivation, and social-emotional and behavioral outcomes. Mixed method findings revealed high feasibility and acceptability of the S-L intervention as indicated by consistent attendance and enthusiastic engagement by staff and youth, high satisfaction, high completion rates of planned sessions, and emergent qualitative themes from staff interviews and adolescent focus groups highlighting that service-learning (1) facilitated skills (e.g., goal-setting, social-emotional and behavioral regulation, and problem-solving), (2) shaped perspectives and inspired openness, and (3) created a space for all to feel valued and included to address the inequities of education that directly impacted them. There was preliminary evidence for efficacy in that youth report of emotional symptoms, peer problems, and staff report of general internalizing symptoms decreased following the intervention, while youth report of prosocial behaviors increased. Implications suggest that S-L programming demonstrates promise to promote mental health outcomes, raise social awareness, and inspire critical consciousness and lift the voices of Black youth by providing tools for working toward systemic changes to reduce inequities in both education and mental health.

Philosophical inquiry in a culturally diverse, faith-based community

This paper reports on collaborative research undertaken with the African Australian Christian Impact Centre (CIC) in Perth, Western Australia. It is part of a larger university philosophy outreach program in which the researchers seek to create opportunities for those on the educational and social margins, and young people, to engage in ‘doing philosophy’, and to learn from them about their experiences. We were interested to evaluate whether the collaborative philosophical inquiry methods we use in our university teaching could be beneficial outside of a formal educational setting, for members of the culturally diverse, faith-based community of CIC. In this multi-method evaluative study, we examined the extent to which participation in a series of Community of Inquiry (CoI) sessions improved or did not improve participants’ self-assessment of: (1) their competence and confidence in communicating with others in different contexts; (2) their competence and confidence as a ‘thinker’; and (3) their social competence and confidence. Our findings on ‘communication’ are discussed in this paper. The facilitated philosophical discussions led to insights about ‘speaking out’ and ‘listening’, particularly with respect to participants’ experiences of cultural and generational differences. We suggest that participation in CoI in a faith-based community setting has the potential to significantly increase confidence in communication skills, and lead to greater intergenerational, intercultural, and intercommunity sensitivity.

Piloting a Faith-Based Hypertension Self-Care Program in a Church Setting.

Health promotion strategies offered in a faith-based setting can be effective in influencing positive self-care behaviors related to hypertension. Faith-based organizations are ideal places to reach vulnerable populations to improve blood pressure management and make a lasting impact. The purpose of this pilot study was to provide a 4-week management program to improve hypertension self-care among a congregation of African Americans. Results revealed improvements among participants related to self-care as well as lowered blood pressure readings.

Seeking Healing for a Mental Illness: Understanding the Care Experiences of Service Users at a Prayer Camp in Ghana.

Human rights abuses in mental health care are a global concern. Addressing the problem requires input from key stakeholders, particularly from people using mental health services. This study explored the experiences of persons with mental illness receiving care in a faith-based setting in Ghana. The study employed a qualitative design, with in-depth interviews (n = 23) and focus groups (n = 18 participants in 3 groups). The constant comparative method of analysis was used to identify themes in participants' descriptions of their experiences. The first three themes identified are consistent with human rights and coercion, and the last twothemes related to service users' views on participation in spiritual practices. Themes included: decision-making around care; consent and efficacy of religious healing; experiences with chaining; views around biomedical treatment; participation in religious activities as part of healing and recognition of the need for spiritual healing. It was observed that participants with prior experience of psychiatric treatment were happy about the absence of chaining in psychiatric facilities but strongly disliked the side effects of medications. These findings underscore the need for faith-based institutions to provide care that is consistent with patient preferences, thereby helping to address the resultant human rights abuses.

Barriers and Facilitators of Fruit and Vegetable Consumption among Nigerian Adults in a Faith-Based Setting: A Pre-Intervention Qualitative Inquiry.

Background:Inadequate consumption of fruit and vegetable is a risk factor for morbidity and mortality associated with non-communicable diseases (NCDs). An understanding of the barriers and facilitators to consumption is important for effectiveness of intervention in Africa. We present insights among church members before developing a church-based multi-component intervention to address the inadequate consumption of fruit and vegetable. Methods: We conducted eighteen focus group discussions among 163 church members. All discussions were audio-taped, transcribed verbatim, and were analyzed for thematic content. Results:We identified five main themes; Personal: awareness and knowledge of benefits, choice, habits, and curiosity, dietary restrictions and gastrointestinal symptoms following fruit and vegetable consumption. Familial: practices promoting the ready availability of fruit and vegetables in the home or habits that encourage children to eat vegetables as they transition into adulthood, pre-existing health problems of family members and the long preparation time of some traditional vegetables. Socio-cultural: Cultural practices that encourage F&V consumption, the high cost of fruits and vegetables, alternatives foregone, and cultural taboos. Environmental: inadequate farmland and storage facilities, seasonality of several fruit and vegetables, and sharp practices of force-ripening with chemicals. Church-related: inadequate space provided by the church for arable cultivation and lack of knowledge of the benefits among church leaders, church activities that involve serving fruits and vegetables and the biblical support for the consumption of fruits and vegetables. Conclusion:It is essential to leverage practices that promote fruit and vegetable intake and address barriers mentioned by the participants when designing such interventions.

Reflections of Buddhist priests who started a dementia carers’ café in Japan

Faith-based organizations are a potential global resource; however, details of their activities have not been fully explored in the academic literature. In Japan, little is known about delivering support for dementia caregivers in a faith-based setting. In this study, we spoke with priests who started carers' cafés to support people who have dementia and people who care for them. These "carers' cafés" are set up in temples and this movement is slowly expanding. The aim of this study was to (1) provide a detailed description of a carers' café and (2) report the reflections of the Buddhist priests who have been involved in the project from the beginning. We conducted in-depth interviews with five Buddhist priests who pioneered the carers' café movement, and conducted a thematic analysis of the transcripts using a qualitative descriptive approach. Six prominent themes were identified: "A carers' café aligns with Buddhist doctrine," "...reveals the strengths of Buddhism and its temples," "...facilitates priests' personal growth," and "...introduces viewpoints from outside of Buddhism." Carers' cafés set up in temples have a positive impact on the Buddhist priests who are involved and on the visitors. One possible reason for this is that the relationship between the temple and the local residents has a long history and thus provides a sense of security for those who are suffering from the realities related to dementia. To create a more inclusive society, it is necessary for secular entities to support this new movement.

Addressing Diabetes Distress in Self-Management Programs: Results of a Randomized Feasibility Study.

BackgroundWest Virginia ranks 1st nationally in the prevalence of hypertension (HTN; 43.8%) and diabetes (16.2%). Patients with type 2 diabetes mellitus (T2DM) are distressed over physical and psychological burden of disease self-management.MethodsThis study investigated the effectiveness of an intervention to reduce diabetes distress and outcomes [glycemic control, blood pressure (BP)] among T2DM adults with comorbid HTN. Participants were randomized to a 12-week diabetes and hypertension self-management program versus a 3-month wait-listed control group. Trained health coaches and experts implemented the lifestyle program in a faith-based setting using an adapted evidence-based curriculum. Twenty adults with T2DM and HTN (n=10 per group) completed baseline and 12-week assessments. Diabetes distress was measured by using a validated Diabetes Distress Survey (17-item Likert scale; four sub-scales of emotional burden, physician related burden, regimen related burden, and interpersonal distress). Baseline and post-intervention changes in diabetes distress were compared for both groups; reduction in distress in the intervention groups are depicted using waterfall plots. The mean age, HbA1c and BMI were 55 ± 9.6 years, 7.8 ± 2.24 and 36.4 ± 8.8, respectively. Diabetes distress (total; mean) was 1.84±0.71.ResultsParticipants reported higher diabetes distress related to emotional burden (2.1±0.94) and regimen-related distress (2.0 ± 0.74); physician-related distress was the lowest (1.18±0.64). In general, diabetes distress reduced among intervention participants and was especially significant among those with HbA1c ≤ 8% (r=0.28, p=0.4), and systolic/diastolic BP ≤140/80 mm Hg (r=0.045, P=0.18).ImplicationsFindings suggest that lifestyle self-management programs have the potential to reduce diabetes distress.

Intersection of Cultural and Religious Beliefs About Mental Health: Latinos in the Faith-Based Setting

Hispanics/Latinos utilize mental health care at a rate that is about half that of non-Hispanic Whites. Stigma and cultural and religious values play a significant role in mental health care utilization disparities. The purpose of this study was to explore beliefs about mental illness among Latino faith-based communities. A qualitative approach was used to explore perceptions of mental illness that were elicited during "El Buen Consejo," a mental health literacy intervention delivered within three faith-based settings. Participants were socialized to believe that persons with mental illness were dangerous, out of control, and suffering from an incurable illness that resulted in rejection and ostracism. Most families would deny the existence of depression and mental illness, unless symptoms greatly interfered with daily functioning or were life-threatening. Religious coping such as prayer, and faith in God, were believed to be protective factors. Causal attributions for depression were both biomedical and religious, such as lack of faith, not praying, demons, and sinful behaviors of parents. Latinos rely upon churches as a major social, educational, and spiritual resource. The cultural values among Latinos can be a source of strength but also contribute to stigma. The faith-based community is an important target for mental health literacy and antistigma interventions.

Rise Up, Get Tested, and Live: an Arts-Based Colorectal Cancer Educational Program in a Faith-Based Setting.

Engaging community members in efforts to reduce cancer-related health disparities through community mini-grant programs has been shown to have meaningful impact. A predominantly African-American church in South Carolina was awarded a community mini-grant to increase awareness about colorectal cancer (CRC) screening among disproportionally high-risk African-American communities through culturally appropriate arts-based cancer education. The church's pastor, health and wellness ministry, and drama ministry created a theatrical production called Rise Up, Get Tested, and Live. Over 100 attendees viewed the play. A pre/post-test evaluation design assessed the effectiveness of the production in increasing participants' knowledge about CRC and examined their intentions to be screened. Results showed increased knowledge about CRC, increased awareness and understanding about the importance of CRC screening, and favorable intentions about CRC screening. Findings suggest that arts-based cancer education may be an effective tool for the dissemination of information about CRC screening.

Community Health Advisors' Participation in a Dissemination and Implementation Study of an Evidence-Based Physical Activity and Healthy Eating Program in a Faith-Based Setting.

Community health advisors (CHAs) have been widely involved in health promotion, but few details on role expectations, retention, and evaluation have been reported. In a dissemination and implementation (D&I) study of an evidence-based healthy eating and physical activity program, 59 churches were randomized to an intervention (n = 39) or control (delayed intervention) (n = 20) condition. In a novel approach, CHAs worked with church committees rather than congregants by providing training (n = 59) and technical assistance (n = 54) to the committees to implement a program focused on structural and policy-level changes to support congregants' behavioral changes. CHA training comprised self-study via electronic training modules, in-person training, and telephone-based training. Evaluation methods were pilot test participants' and CHAs' ratings of their training; observers' ratings of CHAs' church training delivery; church committee members' ratings of the training experience, including CHAs' performance; and data from the TA database to assess CHAs' adherence to the protocol. The main challenge was the early dropout of one CHA and the reduced role of another. CHAs trained 142 intervention and 60 control church committee members in nine sessions; they covered 99% (intervention) and 90% (control) of training content, indicating high fidelity. Observers' scored CHAs' teaching and facilitation skills at 96.7% (intervention) and 80% (control) of the possible score. CHAs completed 92% of intervention and 93% of control TA calls. The great majority of church participants' comments regarding CHAs were positive. This study demonstrates that with training and support, CHAs demonstrate high levels of intervention fidelity, confidence, and competence.

Hypertension in the Faith Community: A Four-Week, Nurse Led, Diet/Exercise Intervention.

Inadequate blood pressure (BP) control in hypertension carries a major financial and public health burden. This study examined the efficacy of behavioral and lifestyle changes on BP control among African American adults, aged 55 years and older in a faith-based setting. The study was supported by clergy who helped to engage participants in interventions. Nurse-led diet and exercise teaching with BP monitoring led to lower BP readings over a 4-week intervention.

A Pilot Study of a Novel Method of Measuring Stigma about Depression Developed for Latinos in the Faith-Based Setting.

In order to understand the effects of interventions designed to reduce stigma about mental illness, we need valid measures. However, the validity of commonly used measures is compromised by social desirability bias. The purpose of this pilot study was to test an anonymous method of measuring stigma in the community setting. The method of data collection, Preguntas con Cartas (Questions with Cards) used numbered playing cards to conduct anonymous group polling about stigmatizing beliefs during a mental health literacy intervention. An analysis of the difference between Preguntas con Cartas stigma votes and corresponding face-to-face individual survey results for the same seven stigma questions indicated that there was a statistically significant differences in the distributions between the two methods of data collection (χ(2)=8.27, p=0.016). This exploratory study has shown the potential effectiveness of Preguntas con Cartas as a novel method of measuring stigma in the community-based setting.

Factors associated with seasonal influenza immunization among church-going older African Americans

ObjectivesChurches and faith institutions can frequently influence health behaviors among older African Americans. The church is a centerpiece of spiritual and social life among African American congregants. We explored its influence on influenza immunization coverage during the 2012–2013 influenza season. MethodsA cross-sectional study was conducted among congregation members ages 50–89 years from six churches in the Atlanta region in 2013–2014. We computed descriptive statistics, bivariate associations, and multivariable models to examine factors associated with immunization uptake among this population. ResultsOf 208 study participants, 95 (45.7%) reported receiving the influenza vaccine. Logistic regression showed that increased trust in their healthcare providers’ vaccine recommendations was a positive predictor of vaccination among participants who had not experienced discrimination in a faith-based setting (OR: 14.8 [3.7, 59.8]), but was not associated with vaccination for participants who had experienced such discrimination (OR: 1.5 [0.2, 7.0]). Belief in vaccine-induced influenza illness (OR: 0.1 [0.05, 0.23]) was a negative predictor of influenza vaccination. ConclusionMembers of this older cohort of African Americans who expressed trust in their healthcare providers’ vaccine recommendations and disbelief in vaccine-induced influenza were more likely to obtain seasonal influenza immunization. They were also more likely to act on their trust of healthcare provider's vaccine recommendations if they did not encounter negative influenza immunization attitudes within the church. Having healthcare providers address negative influenza immunization attitudes and disseminate vaccine information in a culturally appropriate manner within the church has the potential to enhance future uptake of influenza vaccination.

Physical activity promotion among churchgoing Latinas in San Diego, California: Does neighborhood cohesion matter?

This study examined the reciprocal relationship between Latinas' leisure-time physical activity and neighborhood cohesion following the implementation of a 6-month promotora-delivered pilot intervention. A one-group study design was used to promote leisure-time physical activity and build neighborhood cohesion among 143 churchgoing Latinas in San Diego, California. Using a three-wave autoregressive cross-lagged panel model, leisure-time physical activity and neighborhood cohesion (assessed at baseline, 3 and 6 months) were analyzed. Leisure-time physical activity and neighborhood cohesion increased across time. Neighborhood cohesion at 3 months predicted leisure-time physical activity at 6 months. A promotora model in the context of a faith-based setting may be appropriate to promote Latinas' leisure-time physical activity and make socioenvironmental improvements.

Abstract B12: “Present Your Body”: Cancer awareness within the African American faith community in South Los Angeles.

Abstract Introduction: The overarching goal of the “Present Your Body” study was to gather data from the African American faith community (the most well attended hub of information dissemination, service and advocacy in the African American Diaspora), relative to cancer awareness and behaviors associated with prevention, screenings for detection, and adherence. The specific aim of this submission is to examine the relationship between access to health care and knowledge of cancer screening tests and guidelines and cancer prevention, and attitudes towards early detection of cancer. Methods: We used a community partnered-participatory research approach to develop our study aims and survey design. After IRB approval, the Principal Investigator (PI) conducted the community-engagement tasks with 13 churches - successfully garnering participation of 11 predominantly African American churches, including African Methodist Episcopal, Baptist, Seventh Day Adventist, and Non-Denominational churches. Church membership ranged from 50 to over 700. On the day of data collection, the PI and one of the Co-PI's described the study and consent form to potential respondents at a designated time during the church service. Participants completed a self-administered survey in English. Assistance with reading the survey was provided to 45 respondents requesting additional support. Survey participation ranged from 11 to 149 per church. Results: Of the 801 respondents (96%, African Americans, 4%, other), 75 individuals (9.4%) reported that they have been diagnosed with a cancer, including 25 with breast cancer, 17 with cervical cancer and 13 with prostate cancer. Although 503 (63%) of respondents reported that one of their family members (blood relatives) had been diagnosed with some type of cancer, 49% of respondents aged 50 and older had never discussed their personal risk of cancer with a doctor. Approximately 20% of participants had no health insurance. Four out of five respondents did not have a regular or primary care physician and 11% usually went to a hospital emergency room when they were sick or needed advice about their health. One out of five participants reported fair or poor health. Results of the one-way ANOVAS examining associations between access to health care and cancer related knowledge and beliefs showed that respondents 1) with no health insurance, 2) who did not have a regular doctor, 3) who reported using a non-office based physician when they need medical care, and 4) who did not visit a physician within the last two years for a routine checkup or general physical exam all reported a lower level of perceived and test-based cancer prevention and screening knowledge. Similarly, they reported belief in less favorable survival outcomes even when cancers are detected early. Conclusions: Confirming previous studies, our data shows an association between lack of access to primary care among African Americans in a faith-based setting and a lower level of knowledge of cancer screening and prevention. Findings from this study will be shared with the participating churches in an effort to inform future programs to promote cancer awareness and early detection and programs for cancer survivors. Acknowledgment: This work was supported by: 1) the CDU/UCLA Cancer Center Partnership to Eliminate Cancer Health Disparities, NIH/NCI Grant # U54-CA-143931-03 (PI: Vadgama JV); and 2) the NIH/NIMHD grant U54MD007598 (formerly U54RR026138) (PI: Norris, K). Citation Format: Anna Aziza Lucas-Wright, Loretta Jones, James L. Smith, Roberto Vargas, Jaydutt V. Vadgama, Annette E. Maxwell, Mohsen Bazargan. “Present Your Body”: Cancer awareness within the African American faith community in South Los Angeles. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B12.

A Collaborative HIV Prevention and Education Initiative in a Faith-based Setting

Erika Aaron, MSN, is director of Women’s Services, Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania. Lucy Yates, EdD, is health ministry representative, Neighbor-to-Neighbor Community Development Corporation, Inc., Sharon Hill, Pennsylvania. Shannon Criniti, MPH, is manager, Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.

Abstract B19: Developing HPV educational programs in faith-based settings: Results of a community-based participatory research study

Abstract Purpose: African-American (AA) women in South Carolina experience excess cervical cancer incidence and mortality despite reporting higher rates of screening. The reasons for this observation are complex and not well understood. The faith-based setting is potentially a model setting to address cancer disparities. The purpose was to explore the acceptance of and opportunities for providing HPV vaccine education in faith-based settings. Methods: The research was community-based and participatory and conducted in collaboration with the State Baptist Young Woman's Auxiliary Health Ministry members in Region 6, five churches (Manning Baptist Church, New Hopewell Baptist Church, Little Mt. Zion Baptist Church, Mt. Pisgah Baptist Church, and Majority Baptist Church), and Carolina Community Based Health Supports Networks. Church liaisons and community data collectors were trained to identify, recruit, and collect data from eligible participants using a closed-ended questionnaire and semi-structured guide. Descriptive data were analyzed in SAS. Qualitative data were analyzed and interpreted using constant comparison and content analysis methods. Results: A total of 20 in-depth interviews and 10 focus groups (96 participants) were conducted. All participants (n=116) were AA and the majority of participants were female (92%); were insured (95%); had completed high school or beyond (89%). The mean age of participants was 38.8 years. Less than half (41%) correctly identified HPV as a main cause of cervical cancer, but 75% of participants had heard of HPV. Most participants (77%) supported a school requirement for HPV vaccination. The in-depth interviews and focus groups provided information on the content and nature of cervical cancer prevention and control educational programs, including HPV vaccines, in faith-based settings. Most participants felt that the church was an appropriate setting for HPV education and discussions about the HPV vaccine and emphasized the importance of involving youth and adults in such efforts. While there was support for HPV vaccination, there were several comments regarding the age, safety, and unknown aspects of the HPV vaccine. Findings were presented back to participants and interested others in feedback sessions held in the partnering churches. Conclusion: Participants’ knowledge of HPV and cervical cancer was average. There was general interest and support of the HPV vaccine among participants, but participants want more information, especially regarding safety. According to participants, the church is an ideal place to conduct programs, but programs need buy-in, support, and collaboration from leaders and stakeholders. Youth and adults should be the focus of such a program planned in partnership with church leaders. There was much discussion on the importance of engaging youth. The findings from this study are encouraging and show that this population of southern, AA church members are accepting of the HPV vaccine, feel that HPV education is needed, and are receptive to an HPV and cervical cancer educational program in the church. The findings are being used to inform development of faith-based interventions to increase knowledge about HPV and cervical cancer and promote informed decision making about HPV vaccines, and potentially decrease excess cervical cancer mortality. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B19.

Implementation of the fit body and soul, a church-based life style program for diabetes prevention in high-risk African Americans: a feasibility study.

The purpose of this study was to determine the effects of a behavioral faith-based diabetes prevention program called the Fit Body and Soul program in a semi-urban African-American church using a community-based participatory approach. The 12-session Fit Body and Soul program was modified from the group lifestyle balance intervention that was modified from the successful National Institute of Health (NIH) funded Diabetes Prevention Program. The Fit Body and Soul program was implemented in a semi-urban African-American church community. Based on the results of physical examinations and increased body mass index (BMI > or = 25), 40 adult members of the church were identified as being at high risk for diabetes. Four church ministers, after receiving Fit Body and Soul program training for 2 days, served as study interventionists. The primary objective was weight loss of at least 5% by the end of the 12-session Fit Body and Soul intervention. Screening of church participants was conducted at the Gospel Water Branch Baptist Church in Augusta, Georgia. A total of 40 individuals having a BMI > or = 25 were selected. Of the 40, a total of 35 (87.5%) attended at least 10 sessions and provided information required for the study. Of the 35, a total of 48% lost at least 5% of baseline weight, 26% lost 7% or more, and 14% lost >10% of baseline weight. This pilot trial suggests that carrying out a larger Fit Body and Soul study in a faith-based setting, using behavioral lifestyle interventions, in the context of a diabetes prevention program for African American communities is feasible, as is the possibility that subjects in that larger study will achieve a clinically significant degree of weight loss.

INSPIRE Curriculum Delivered in a Faith-Based Setting

African Americans have the highest asthma rates of any racial/ethnic group. A sample of African American caregivers between 25 and 45 years of age who were the primary caregiver of an asthmatic child participated in this study. The main purpose of this study was to evaluate the feasibility of delivering an educational intervention that promotes best practices for the medical management of asthma in a peer education format. The study consisted of focus groups and workshops. The INSPIRE curriculum, when adapted in a church-based setting, represents a promising brief tool for training peer educators to disseminate asthma information.