Rural African American Communities Research Articles

The health of rural Black communities during COVID: Some affirmations, some surprises.

There are overwhelming health disparities in the Deep South. It is important to include the voice of communities affected by these disparities when developing interventions. The goal of the current study was to develop an academic community engaged partnership to strengthen the ability to address priority health concerns of rural African American communities with a focus on health literacy and health advocacy. A community-based participatory research approach was used to administer a 15-item community health survey in five rural communities led by African American mayors in Alabama (N = 752). The survey assessed the health concerns and the potential behaviors that may be associated with those health concerns. The five communities demonstrated similarities as well as differences in both the health concerns endorsed and the potential health behaviors that may contribute to those concerns. All five communities identified cardiovascular disease as a health concern with three endorsing mental health issues and 2 dental health. With respect to behaviors, all five communities identified either unhealthy eating/exercise and substance use as concerns with one community identifying racism as a risky behavior affecting health. The results presented replicate CBPR studies demonstrating that communities are important sources of information about local health priorities and concerns.

Grappling With Ideas: Adolescent Writers in a Rural African American Community

AbstractAn African American teacher and students engaged in meaningful reading and writing that included African American literature. These literacy experiences allowed the development of cultural models through exploring identity, questioning dominant narratives, and building capacity for literary analysis. This study shows how meaningful literacy pedagogy for African American students can be implemented during the school day despite the pressures of a heavily constrained curriculum.

Being African American and Rural: A Double Jeopardy From COVID-19.

Being African American and Rural: A Double Jeopardy From COVID-19.

Developing and Testing the Feasibility of a Culturally Based Tele-Palliative Care Consult Based on the Cultural Values and Preferences of Southern, Rural African American and White Community Members: A Program by and for the Community.

Purpose: Lack of appreciation of cultural differences may compromise care for seriously ill minority patients, yet culturally appropriate models of palliative care (PC) are not currently available in the United States. Rural patients with life-limiting illness are at high risk of not receiving PC. Developing a PC model that considers the cultural preferences of rural African Americans (AAs) and White (W) citizens is crucial. The goal of this study was to develop and determine the feasibility of implementing a culturally based PC tele-consult program for rural Southern AA and W elders with serious illness and their families, and assess its acceptability to patients, their family members, and clinicians.Methods: This was a three-phase study conducted in rural Beaufort, South Carolina, from January 2013 to February 2016. We used Community-Based Participatory Research methods, including a Community Advisory Group (CAG) with equal numbers of AA and W members, to guide the study. Phase 1: Cultural values and preferences were determined through ethnic-based focus groups comprising family members (15 W and 16 AA) who had cared for a loved one who died within the past year. We conducted a thematic analysis of focus group transcripts, focused on cultural values and preferences, which was used as the basis for the study protocol. Phase 2: Protocol Development: We created a protocol team of eight CAG members, two researchers, two hospital staff members, and a PC physician. The PC physician explained the standard clinical guidelines for conducting PC consults, and CAG members proposed culturally appropriate programmatic recommendations for their ethnic group for each theme. All recommendations were incorporated into an ethnic-group specific protocol. Phase 3: The culturally based PC protocol was implemented by the PC physician via telehealth in the local hospital. We enrolled patients age ≥65 with a life-limiting illness who had a family caregiver referred by a hospitalist to receive the PC consult. To assess feasibility of program delivery, including its acceptability to patients, caregivers, and hospital staff, using Donebedian's Structure-Process-Outcome model, we measured patient/caregiver satisfaction with the culturally based consult by using an adaptation of FAMCARE-2.Results: Phase 1: Themes between W and AA were (1) equivalent: for example, disrespectful treatment of patients and family by hospital physicians; (2) similar but with variation: for example, although religion and church were important to both groups, and pastors in both ethnic groups helped family face the reality of end of life, AA considered the church unreservedly central to every aspect of life; (3) divergent, for example, AAs strongly believed that hope and miracles were always a possibility and that God was the decider, a theme not present in the W group. Phase 2: We incorporated ethnic group-specific recommendations for the culturally based PC consult into the standard PC consult. Phase 3: We tested feasibility and acceptability of the ethnically specific PC consult on 18 of 32 eligible patients. The telehealth system worked well. PC MD implementation fidelity was 98%. Most patients were non-verbal and could not rate satisfaction with consult; however, caregivers were satisfied or very satisfied. Hospital leadership supported program implementation, but hospitalists only referred 18 out of 28 eligible patients.Conclusions: The first culturally based PC consult program in the United States was developed in partnership with AA and W Southern rural community members. This program was feasible to implement in a small rural hospital but low referral by hospitalists was the major obstacle. Program effectiveness is currently being tested in a randomized clinical trial in three southern, rural states in partnership with hospitalists. This method can serve as a model that can be replicated and adapted to other settings and with other ethnic groups.

3113 Formative Evaluation of a Safety Baby Shower Intervention for Rural African American Parents and Community Advisors

OBJECTIVES/SPECIFIC AIMS: To explore rural African American parents’ and their community advisors’ perspectives on the Safety Baby Shower’s acceptability, feasibility, and adaptability. METHODS/STUDY POPULATION: Collaborating with a local community organization, we explored community advisors’ and expectant women’s SBS experiences to understand intervention delivery and adoption in a rural underserved community (RUC). The Consolidated Framework for Implementation Research guided our data collection and analysis using focus groups and key informant interviews. We used directed content analysis to generate themes and sub codes. RESULTS/ANTICIPATED RESULTS: Five focus groups (21 participants) and one key informant interview were conducted. Identified barriers that hinder feasibility and acceptability included resources, time/ flexibility, intervention location, cultural norms and beliefs, and the lack of a birthing hospital in the county. “Baby proofing”, “reinforcement products” and “teaching sleep safety on the same day as infant clinical appointment” are expectant mothers’ exemplars for what comes to their minds when asked to think about safety baby showers. To improve feasibility, both community advisors and expectant mothers suggested adaptations ranging from decentralizing or rotating intervention location, using different delivery sites such as churches, scheduling intervention outside business hours, to incorporating intervention into school health fairs and barbeque events. Social media emerged as a facilitator, and integrating safe sleep education into personal baby showers emerged as an implementation strategy. DISCUSSION/SIGNIFICANCE OF IMPACT: The community advisors and expectant mothers identified a wide spectrum of potential adaptations that have potential to improve safe sleep knowledge and practices. In the next study phase, identified themes will inform intervention adaptation and suggested implementation strategies will support uptake of the adapted SBS. Identifying transformative implementation strategies and conducting a community-informed SBS adaptation using a collective decision-making process between intervention experts and local community partners will support improved safety baby shower delivery, adoption and sustainability in RUCs.

Depressive symptoms and psychological distress among rural African Americans: The role of material hardship and self-rated health

BackgroundDespite experiencing conditions associated with higher risk for depression and psychological distress, the mental health of rural African Americans remains understudied. This brief report examines the association between sociodemographic characteristics, self-rated health, and material hardship, and depressive symptoms and psychological distress among rural African Americans. MethodData are from the rural African American subsample (N = 250) of the National Survey of American Life (NSAL; 2001–2003). The Center for Epidemiological Studies-Depression Scale (CES-D) was used to assess depressive symptoms. Psychological distress was measured using the Kessler 6 (K6). Negative binominal regression analyses were performed. ResultsRural African Americans reporting more material hardship and poorer self-rated physical health had higher levels of depressive symptoms and psychological distress compared to counterparts with less hardship and better self-rated health. Findings also suggest rural African American women had more depressive symptoms compared to male peers. Older rural African Americans and African Americans with fewer years of education had more symptoms of psychological distress than their respective counterparts. LimitationsThough the NSAL represents the only national probability survey on African Americans’ mental health; the timeliness of the data, collected between 2001 and 2003 is a limitation. ConclusionsMaterial hardship and worse self-rated health emerged as risk factors for depression and psychological distress among this population. This suggests the need for systems of care and integrated healthcare models across service providers within rural African American communities to promote adequate screening, intervention, and referrals related to economic, physical, and mental health needs.

Reducing depressive symptoms through behavioral activation in churches: A Hybrid-2 randomized effectiveness-implementation design

Rural African Americans are disproportionately exposed to numerous stressors such as poverty that place them at risk for experiencing elevated levels of depressive symptoms. Effective treatments for decreasing depressive symptoms exist, but rural African Americans often fail to receive adequate and timely care. Churches have been used to address physical health outcomes in rural African American communities, but few have focused primarily on addressing mental health outcomes. Our partnership, consisting of faith community leaders and academic researchers, adapted an evidence-based behavioral activation intervention for use with rural African American churches. This 8-session intervention was adapted to include faith-based themes, Scripture, and other aspects of the rural African American faith culture (e.g. bible studies)This manuscript describes a Hybrid-II implementation trial that seeks to test the effectiveness of the culturally adapted evidence-based intervention (Renewed and Empowered for the Journey to Overcome in Christ: REJOICE) and gather preliminary data on the strategies necessary to support the successful implementation of this intervention in 24 rural African American churches. This study employs a randomized one-way crossover cluster design to assess effectiveness in reducing depressive symptoms and gather preliminary data regarding implementation outcomes, specifically fidelity, associated with 2 implementation strategies: training only and training+coaching calls.This project has the potential to generate knowledge that will lead to improvements in the provision of mental health interventions within the rural African American community. Further, the use of the Hybrid-II design has the potential to advance our understanding of strategies that will support the implementation of and sustainability of mental health interventions within rural African American faith communities.Trial registration: NCT02860741. Registered August 5, 2016

Addressing Mental Health Needs: Perspectives of African Americans Living in the Rural South.

Rural African Americans are disproportionately affected by social stressors that place them at risk of developing psychiatric disorders. This study aimed to understand mental health, mental health treatment, and barriers to treatment from the perspective of rural African-American residents and other stakeholders in order to devise culturally acceptable treatment approaches. Seven focus groups (N=50) were conducted with four stakeholder groups: primary care providers, faith community representatives, college students and administrators, and individuals living with mental illness. A semistructured interview guide was used to elicit perspectives on mental health, mental health treatment, and ways to improve mental health in rural African-American communities. Inductive analysis was used to identify emergent themes and develop a conceptual model grounded in the textual data. Stressful living environments (for example, impoverished communities) and broader community-held beliefs (for example, religious beliefs and stigma) had an impact on perceptions of mental health and contributed to barriers to help seeking. Participants identified community-level strategies to improve emotional wellness in rural African-American communities, such as providing social support, improving mental health literacy, and promoting emotional wellness. Rural African Americans experience several barriers that impede treatment use. Strategies that include conceptualizing mental illness as a normal reaction to stressful living environments, the use of community-based mental health services, and provision of mental health education to the general public may improve use of services in this population.

African American Perspectives and Experiences of Domestic Violence in a Rural Community.

Relatively few studies have explored domestic violence from a multiplicity of African American perspectives, experiences, and socio-demographic backgrounds within rural African American communities. Community-based participatory action research methods were used to explore domestic violence perceptions of African Americans with heterogeneous backgrounds and experiences of violence. Ten focus groups were held throughout the community with 52 diverse women (n = 33) and men (n = 19) living in the northwest region of Arkansas. Demographic data were collected from 47 women (n = 28) and men (n = 19) participating in focus groups regarding their perceptions and experiences of domestic violence, media messages, help-seeking behaviors, and services. Data were analyzed using grounded theory methods. Three major themes emerged, including (a) a heightened awareness of race, gender, and class differences; (b) imbalanced and mixed messages from media; and (c) multi-systemic dynamics influencing abusive behavior and relationships. Results indicate that study participants' perspectives and experiences with domestic violence reflect a complex interrelated gamut of societal, community, familial, and individual dynamics. Participant recommendations related to interpersonal dynamics, media messages, and societal influences are reported with implications for practice, policy, and future research.

Adaptation of a Modified DASH Diet to a Rural African American Community Setting.

Cardiovascular disease is the leading cause of death among African Americans in the U.S., with high blood pressure and obesity being two of the main determinants. The Dietary Approaches to Stop Hypertension diet is effective in changing behaviors associated with these health concerns, but has not been adapted to community settings. Men on the Move: Growing Communities (MOTMGC) was evaluated using a quasi-experimental cross-sectional design. Surveys were conducted with rural African Americans aged ≥18 years prior to the intervention (2008) and at the end of the project (2013), with the final analysis conducted in 2015. Using a community-based participatory research approach, MOTMGC provided culturally appropriate education and changes to the environment to improve access to fruits and vegetables, low-fat, and low-sodium foods. Declines in prevalence of overweight and obese respondents and hypertension were seen in the intervention but not the comparison county. Participants with high levels of participation reported eating five or more servings of fruits and vegetables a day, a greater variety of fruits and vegetables, less salt, and seasoning their vegetables with less fat more often than those who did not participate in educational activities. Participants reported that as a result of their access to MOTMGC gardens, they were more likely to eat more fruits, vegetables, and locally grown food, and less processed food and fast food. Adapting the Dietary Approaches to Stop Hypertension diet to community settings through culturally appropriate community-based efforts can improve dietary behaviors, BMI, and blood pressure.

Abstract A27: Recruitment methods for engaging rural African American populations in community-based research

Abstract There is a paucity of data on African Americans in community-based research secondary to difficulties in recruitment. These challenges include transportation, outreach barriers, fear and mistrust of researchers, lack of knowledge about disorder/issue under study, and lack of incentives. We hypothesized that we could improve recruitment in rural African American women by engaging community centers such as churches, community health centers, and doctor's offices. Over a 1 month period, we sought to recruit 40 women for a community based research project with a primary outcome of increasing activity in rural African American women (45-70 years old) with knee pain. The outlets used to recruit these women included: five churches with a community liaison, many primary care physicians' offices, and a newspaper ad. In 1 month, 67 women expressed interest in our program by initiating contact. Of those 67 women, 42 were eligible and 37 were enrolled. Of the 42 eligible women, 24 were recruited from churches, 11 through word of mouth, 3 from physicians' offices, and 3 from the newspaper ad. Lack of literature on how to recruit in rural African American communities is a significant barrier to research participation among African Americans. In this project, we provide a reproducible recruitment process for engaging rural African American women in community based research. While our primary focus was knee pain, this recruitment process can easily be translated into other areas of community based research including cancer and cardiovascular disease among others. Citation Format: Michelle Scott, Tamara Huff, Monica Albertie, Gerardo Colon-Otero. Recruitment methods for engaging rural African American populations in community-based research. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A27.

Racially Associated Disparities in Hospice and Palliative Care Access: Acknowledging the Facts While Addressing the Opportunities to Improve.

Journal of Palliative MedicineVol. 19, No. 2 EditorialsRacially Associated Disparities in Hospice and Palliative Care Access: Acknowledging the Facts While Addressing the Opportunities to ImproveRichard PayneRichard PayneSearch for more papers by this authorPublished Online:3 Feb 2016https://doi.org/10.1089/jpm.2015.0475AboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited by“Palliative Care Is the Only Medical Field That I Feel Like I'm Treated As a Person, Not As a Black Person”: A Mixed-Methods Study of Minoritized Patient Experiences with Palliative Care Julia I. Bandini, Lucy B. Schulson, Claude Messan Setodji, Jhacova Williams, Katherine Ast, and Sangeeta C. Ahluwalia16 August 2022 | Journal of Palliative Medicine, Vol. 0, No. 0“Death is as Much Part of Life as Living”: Attitudes and Experiences Preparing for Death from Older Adults with Sickle Cell Disease20 July 2022 | OMEGA - Journal of Death and DyingDoes Culture Matter? Young and Middle-Aged Iranian-American Adults’ Perspectives Regarding End-of-Life Care Planning9 August 2021 | American Journal of Hospice and Palliative Medicine®, Vol. 39, No. 5Drivers of racial/ethnic differences in perceived end‐of‐life care quality: More questions than answers28 February 2022 | Journal of the American Geriatrics Society, Vol. 70, No. 4Preparedness for Serious Illnesses: Impact of Ethnicity, Mistrust, Perceived Discrimination, and Health Communication3 September 2021 | American Journal of Hospice and Palliative Medicine®, Vol. 39, No. 4Health Professionals Palliative Care Education for Older Adults: Overcoming Ageism, Racism, and Gender Bias30 October 2021 | Current Geriatrics Reports, Vol. 10, No. 4Valuing Black lives and the ‘Good Death’ in the United States5 July 2021 | Sociology of Health & Illness, Vol. 43, No. 8Racial Disparities in Utilization of Palliative Care Among Patients Admitted With Advanced Solid Organ Malignancies6 May 2020 | American Journal of Hospice and Palliative Medicine®, Vol. 38, No. 6Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature8 December 2020 | American Journal of Hospice and Palliative Medicine®, Vol. 38, No. 6Spirituality and the Illness Experience: Perspectives of African American Older Adults19 January 2021 | American Journal of Hospice and Palliative Medicine®, Vol. 38, No. 6Invited Editorials6 May 2021 | Palliative Medicine, Vol. 35, No. 5Geographic Variation in Knowledge of Palliative Care Among US Adults: Findings From 2018 Health Information National Trends Survey6 August 2020 | American Journal of Hospice and Palliative Medicine®, Vol. 38, No. 3A Call to Action to Address Disparities in Palliative Care Access: A Conceptual Framework for Individualizing Care Needs Katie E. Nelson, Rebecca Wright, Marlena Fisher, Binu Koirala, Benjamin Roberts, Danetta H. Sloan, David S. Wu, and Patricia M. Davidson15 January 2021 | Journal of Palliative Medicine, Vol. 24, No. 2Developing and Testing the Feasibility of a Culturally Based Tele-Palliative Care Consult Based on the Cultural Values and Preferences of Southern, Rural African American and White Community Members: A Program by and for the Community Ronit Elk, Linda Emanuel, Joshua Hauser, Marie Bakitas, and Sue Levkoff26 March 2020 | Health Equity, Vol. 4, No. 1Integrative Palliative Care: A New Transformative Field to Alleviate Suffering Delia R. Chiaramonte and Shelley R. Adler18 September 2020 | The Journal of Alternative and Complementary Medicine, Vol. 26, No. 9Dealing with cultural diversity in palliative care21 August 2020 | BMJ Supportive & Palliative Care, Vol. 18Early for EveryoneAdvances in Neonatal Care, Vol. 20, No. 2Promoting advance care planning in African American faith communities: literature review and assessment of church-based programs7 December 2020 | Palliative Care and Social Practice, Vol. 14Apoyo con Cariño (support with caring): RCT protocol to improve palliative care outcomes for Latinos with advanced medical illness10 October 2018 | Research in Nursing & Health, Vol. 41, No. 6Racial and Ethnic Disparities in Palliative Care: A Systematic Scoping Review29 October 2018 | Families in Society: The Journal of Contemporary Social Services, Vol. 99, No. 4Culture and Palliative Care: Preferences, Communication, Meaning, and Mutual Decision MakingJournal of Pain and Symptom Management, Vol. 55, No. 5Quality of Hospice Care at Home Versus in an Assisted Living Facility or Nursing Home10 February 2018 | Journal of the American Geriatrics Society, Vol. 66, No. 4 Volume 19Issue 2Feb 2016 InformationCopyright 2016, Mary Ann Liebert, Inc.To cite this article:Richard Payne.Racially Associated Disparities in Hospice and Palliative Care Access: Acknowledging the Facts While Addressing the Opportunities to Improve.Journal of Palliative Medicine.Feb 2016.131-133.http://doi.org/10.1089/jpm.2015.0475Published in Volume: 19 Issue 2: February 3, 2016PDF download

Developing a Culturally Tailored Palliative Care Program with Guidance from Rural African American and White Community Members: A Program by the Community for the Community (FR461B)

•Gain an understanding of need for cultural tailoring in rural African American and white communities for palliative care (PC) programs.•Hear about a new approach for developing a culturally tailored PC program in collaboration with the community that meets the common and unique needs of African American and white rural elders.•Examine results that are common to both groups and those that are unique to African American or white. A culturally appropriate model of end-of-life care that takes into consideration the diverse cultural preferences of rural, terminally ill African Americans and whites is lacking. To develop a culturally tailored palliative care (PC) program with the guidance of African American and white community members that will meet the common and unique needs of rural elders at end of life. The goal of this second phase of a three-phase study is to gather input from African American and white community members into a future PC program. In the tradition of Community Based Participatory Research (CBPR), a Community Advisory Group (CAG) of community leaders and family members who had recently lost a loved one was formed. The CAG met monthly for a year with the research team and systematically reviewed the qualitative thematic results of the end-of-life care preferences of African American and white caregivers who had participated in focus groups in Phase 1. Based on these preferences, CAG made recommendations for a PC program that would meet the common and unique needs of their communities. Recommendations that were common to both groups include: The Physician should elicit whether family wants to hear about prognosis and treatment and discuss these with compassion and consideration. Recommendations that were unique to African American group include: Physician should respect and state that God or a higher power, and not the physician, determines when the patient will pass. The physician should recognize and appreciate a family’s determination to care for their loved one at home. The family’s pastor is central, and his or her involvement is preferred to that of the hospice chaplain. Developing a culturally tailored PC program in collaboration with the community is feasible and builds trust and ownership. Acceptability of the program will be a hospital-tested program in Phase 3.

Implementing Family-Centered Prevention in Rural African American Communities: a Randomized Effectiveness Trial of the Strong African American Families Program.

Efforts to disseminate evidence-based prevention programs are hampered by a lack of real-world effectiveness trials undertaken with community providers. The Strong African American Families (SAAF) program is an empirically validated intervention designed to prevent problem behavior among rural African American youth. To evaluate the effectiveness of SAAF and its implementation protocols when delivered by a community provider, we conducted a randomized, wait-list-controlled trial with outcome measurements assessed longitudinally at baseline and 6 months after baseline. A total of 465 African American youth and their parents were recruited randomly from public school lists of fifth- and sixth-grade students in eight rural counties in south Georgia. Youth and parents assessed targeted outcomes in their homes. The main outcome, problem behavior vulnerability, was operationalized as a latent construct comprising three indicators: tolerance for deviance, intentions to engage in risky behavior, and affiliations with risk-taking peers. SAAF was implemented with uniformly high levels of adherence (85.5%; SD = 10.8) and attendance (M = 4.1, SD = 2.9, range = 0-7). Intent-to-treat and complier average causal effect analyses revealed significant program effects on intervention-targeted parenting practices, youth self-regulatory processes, and problem behavior vulnerability. SAAF influenced problem behavior vulnerability indirectly via effects on targeted parenting and youth processes. This study supported the effectiveness of SAAF in a community setting when a systematic implementation model supports participant engagement and intervention adherence.

The effect of education plus access on perceived fruit and vegetable consumption in a rural African American community intervention.

African Americans have an increased risk of cardiovascular disease partly due to low fruit and vegetable consumption. This article reports the results of an intervention to provide nutrition education and access to fruits and vegetables through community gardens to change dietary behaviors among African Americans in rural Missouri. Cross-sectional surveys evaluated the intervention effect on blood pressure, body mass index (BMI), and perceived fruit and vegetable consumption in this quasi-experimental study with a comparison group. Hypertension (OR = 0.52, 95% CI: 0.38-0.71) and BMI (OR = 0.73, 95% CI: 0.52-1.02) were lower in the intervention county at mid-intervention. Participation in nutrition education (OR = 2.67, 95% CI: 1.63-4.40) and access to fruits and vegetables from a community garden (OR = 1.95, 95% CI: 1.20-3.15) were independently associated with perceived fruit and vegetable consumption. The strongest effect on perceived fruit and vegetable consumption occurred with high participation in nutrition education and access to community gardens (OR = 2.18, 95% CI: 1.24-3.81). Those with access but without education had a reduced likelihood of consuming recommended servings of fruits and vegetables (OR = 0.57, 95% CI: 0.34-0.95). Education plus access interventions may be best at increasing consumption of fruits and vegetables in a rural African American population.

Development of a Faith-Based Stress Management Intervention in a Rural African American Community.

Faith-based mental health interventions developed and implemented using a community-based participatory research (CBPR) approach hold promise for reaching rural African Americans and addressing health disparities. To describe the development, challenges, and lessons learned from the Trinity Life Management, a faith-based stress management intervention in a rural African American faith community. The researchers used a CBPR approach by partnering with the African American faith community to develop a stress management intervention. Development strategies include working with key informants, focus groups, and a community advisory board (CAB). The community identified the key concepts that should be included in a stress management intervention. The faith-based "Trinity Life Management" stress management intervention was developed collaboratively by a CAB and an academic research team. The intervention includes stress management techniques that incorporate Biblical principles and information about the stress-distress-depression continuum.

Translating an evidence-based diabetes education approach into rural african-american communities: the "wisdom, power, control" program.

Purpose. The aim of this exploratory study was to assess the efficacy of the “Wisdom, Power, Control” diabetes self-management education (DSME) program with regard to diabetes knowledge, self-efficacy, self-care, distress level, and A1C in an African-American population.Methods. A prospective, quasi-experimental, repeated-measure design was employed to measure these outcomes. Study participants were assessed at baseline, 6 weeks post-intervention, and at a 3-month A1C follow-up.Results. A total of 103 participants were recruited from the intervention counties, and 14 were identified from the control counties. At the post-test, participants in the intervention group reported a significantly higher level of diabetes knowledge (Δ = 9.2%, P <0.0001), higher self-efficacy (Δ = 0.60, P <0.0001), more self-care behaviors (Δ = 0.48, P <0.0001), lower distress level (Δ = –0.15, P = 0.05), and higher health status (Δ = 0.49, P = <0.0001). About 56% of the intervention group completed all six classes, and 25% attended five classes.Conclusions. Findings from this study demonstrate the initial success of translating a culturally adapted DSME program into rural African-American communities. The study highlights important lessons learned in the process of implementing this type of program in a real-world setting with a minority population.

Innovative Strategies to Address the Unique Cultural Beliefs and Spiritual Perspectives of African American Patients and Families at the End of Life (TH309)

Recognize how clinicians and organizations are responding to the cultural and spiritual perspectives of African American in endof-life clinical care and program development to understand what is happening in other healthcare settings in the United States. Identify an innovative strategy (that other programs can implement) using community based participatory research in developing a culturally tailored palliative care program for rural African American communities, with full community partnership. Gain insight into an effective method of designing culturally tailored programs that others can incorporate into their own programs.

The WORD (Wholeness, Oneness, Righteousness, Deliverance): design of a randomized controlled trial testing the effectiveness of an evidence-based weight loss and maintenance intervention translated for a faith-based, rural, African American population using a community-based participatory approach

BackgroundThe positive effects of weight loss on obesity-related risk factors diminish unless weight loss is maintained. Yet little work has focused on the translation of evidence-based weight loss interventions with the aim of sustaining weight loss in underserved populations. Using a community-based participatory approach (CBPR) that engages the strong faith-based social infrastructure characteristic of rural African American communities is a promising way to sustain weight loss in African Americans, who bear a disproportionate burden of the obesity epidemic. ObjectivesLed by a collaborative community–academic partnership, The WORD aims to change dietary and physical activity behaviors to produce and maintain weight loss in rural, African American adults of faith. DesignThe WORD is a randomized controlled trial with 450 participants nested within 30 churches. All churches will receive a 16-session core weight loss intervention. Half of the churches will be randomized to receive an additional 12-session maintenance component. MethodsThe WORD is a cultural adaptation of the Diabetes Prevention Program, whereby small groups will be led by trained church members. Participants will be assessed at baseline, 6, 12, and 18months. A detailed cost-effectiveness and process evaluation will be included. SummaryThe WORD aims to sustain weight loss in rural African Americans. The utilization of a CBPR approach and the engagement of the faith-based social infrastructure of African American communities will maximize the intervention's sustainability. Unique aspects of this trial include the focus on weight loss maintenance and the use of a faith-based CBPR approach in translating evidence-based obesity interventions.

Feasibility Study of Engaging Barbershops for Prostate Cancer Education in Rural African-American Communities.

The barbershop is a promising setting where African-American men might receive information and education about prostate cancer. In this study, we assessed the feasibility of engaging rural barbershops as venues for barbers to deliver a prostate cancer education intervention to increase informed decision-making for prostate cancer screening among customers. Twelve barbershops were recruited from two separate micropolitan areas in Georgia as intervention and control sites. Structured interviews were conducted with 11 barbers in both sites about customer characteristics as well as their willingness to participate in the study. The interviews were audio recorded and transcribed for analysis. In the intervention site, six barbers completed a survey and a pre-/posttest prostate cancer knowledge instrument following training classes. Barbers reported a wide average range of customers served per week (50 to 300). African-American men made up an average of 87% of customers. Barbers thought prostate cancer was an important discussion topic, felt they would be comfortable discussing it, and supported the participation of their barbershop in the study. For intervention group barbers, there was a statistically significant difference between the average pretest knowledge score of 72% (mean 12.2, SD=3.2) and the posttest knowledge score of 89% (mean 15.2, SD=1.1) (P=0.03) on the 17-item prostate cancer knowledge instrument. Based on the multiple interactions with the barbers, there was high receptivity to the topic and consensus about the importance of addressing prostate cancer with their customers. Rural barbershops represent feasible venues for delivering a prostate cancer education intervention.