Conducting Health Research in Korean American Churches: Perspectives from Church Leaders

Korean Americans experience many challenges to obtaining adequate health care coverage and access to needed services. Because a large proportion of Korean Americans attend churches on a regular basis, churches may be a promising venue where health programs can be delivered. In order to gain an in-depth understanding of Korean American churches with respect to conducting future health intervention research, we conducted exploratory interviews and focus groups with 58 leaders from 23 Korean American churches and three community organizations. From these interviews and focus groups, we found that Korean churches and church leaders seek to meet a variety of social and health needs of their congregation and their surrounding community. Several leaders have stated that assisting with social and medical needs of their members is an important component of their current ministry. They described profound health needs of their congregations and have suggested various ways in which the university can partner with the local churches to help address these needs through research. Additionally, they described various resources churches can provide to researchers such as: their personal assistance, church volunteer base, church facility, and church network and contacts. Our findings suggest that Korean churches have a high potential to serve an important role in the health of Korean Americans. On the basis of the promising results of the present study, we are planning to conduct a cross sectional survey of Korean church leaders and members in Los Angeles County to substantiate our findings in a larger representative sample.     

Community health promotion: The church as partner

The purpose of this paper is to review the literature relative to church-based health promotion programs to assist health professionals in establishing effective prevention alliances with African-American churches. While the literature describing the role of churches, particularly African-American, is limited, the available evidence supports the assertion that many churches are engaged in providing primary prevention, preventive health, and social services to at risk populations. Two mini-cases, illustrative of programs which have been reported in the literature, are presented. What each program had in common is an alliance between ministers, health professionals, and trained church volunteers. Pastors acted as gatekeepers and advocates for a health program. The health professionals served as consultants (particularly in technical design, training, and evaluation). Interested church members, once trained, conducted health programs serving themselves, fellow members, and their community.     

The African-American church: a potential forum for adolescent comprehensive sexuality education.

PURPOSE: To investigate the attitudes and beliefs of clergy from African-American churches towards sexuality education and the provision of sexuality education in their churches. METHODS: A pilot study was designed to survey a convenience sample of clergy leaders from African-American churches about their young adolescent members. The survey asked about priority health topics, prevalence of sexual and drug risk behavior and the clergy's desire for health education programs. The churches were located in a county (1990 population approximately 200,000, 40% African-American) in the southeastern United States. RESULTS: The respondents' highest priority issues were drugs, violence, HIV/AIDS, pregnancy and alcohol. Many (76%) had discussed one or more of these issues in church. All respondents wanted additional health seminars for their adolescents, though some clergy (30%) excluded some sexual topics (i.e., anal sex, bisexuality, homosexuality, masturbation, oral sex). Only 6% would make condoms available in their churches, but all would allow contraceptive education. CONCLUSIONS: Many African-American churches are open to including sexuality education among their health education offerings for young adolescents. The church should be considered as a potential forum for providing comprehensive sexuality education for African-American adolescents.     

Health promotion in local churches in Victoria: an exploratory study

Church‐based health promotion has increasingly gained attention in strategies to address health disparities. In Australia, we have limited understanding of the role of local churches in health promotion and without this, how they might be involved in meaningful partnerships to tackle public health challenges. The objective of this qualitative study was to explore how churches are involved in health promotion in the state of Victoria. The research involved in‐depth interviews with ministers from 30 churches in urban and rural Victoria, and case studies with 10 of these churches to enable further exploration. These case studies, conducted in 2010, included interviews with church staff, focus groups with volunteers, participant observation and document analysis. Analysis was iterative, utilising open, axial and thematic coding. Three different expressions of church – traditional, new modern and emerging – were identified and found to differentiate the levels and types of health promotion activity. Case studies illustrate the different expressions of how church mission influences health promotion activity. The traditional churches were involved particularly in disease screening and health education activities with their own, predominantly older congregation members. The new modern churches tended to have the material and human resources to be harnessed in health promotion activities involving congregation members and others. Emerging churches, in contrast, engaged in broad health‐promoting activities, including disease prevention, lifestyle activities and socio‐ecological approaches at a community level. These research findings highlight the opportunities and challenges of engaging with local churches in health promotion efforts and public health programmes to address health inequities.     

The urban church and cancer control: a source of social influence in minority communities.

A study was conducted to examine the efficacy of a church-based model of social influence in improving access to and participation of underserved minority women in a cervical cancer control program. The model expanded on strategies used in previous hypertension control and health promotion research. A total of 24 churches, stratified by faith tradition, were randomly selected to participate in the cancer control program from a pool of 63 churches in a defined geographic area of Los Angeles County, CA. Female parishioners ages 21 years and older were eligible to participate in cervical cancer education sessions, and screening was offered to adult women who had not had Papanicolaou tests within the last 2 years. Church participation rate was 96 percent. Thirty lay health leaders were selected by the clergy to serve as messengers, recruiters, and organizers for their respective congregations. Ninety-seven percent of these lay health leaders participated in two training sessions designed to prepare them for their leadership role. Social support structures such as child care, meals, or transportation for targeted women were organized by lay health leaders in 78 percent of the churches. A total of 1,012 women between the ages of 21 and 89 years attended educational sessions. Forty-four percent of the eligible women were targeted for screening because they had not had a Papanicolaou test within the last 2 years or had never been screened. Black women were 6.6 times more likely than Hispanics to have been screened in the past 2 years.(ABSTRACT TRUNCATED AT 250 WORDS)     

Role of Black churches in health promotion programs: lessons from the Los Angeles Mammography Promotion in Churches Program

OBJECTIVES: This article assesses pastor-level factors that affect the successful recruitment and implementation of community-based health promotion programs in Black churches. METHODS: Semistructured interviews with 16 pastors of Black churches were analyzed for content. RESULTS: We found that although the involvement of Black pastors in an array of secular activities makes them open to participate in health programs, their overcommitment to other issues can negatively influence their ability to participate. Second, although Black pastors appreciate being included in and benefiting from health research, minorities' history of being underserved and exploited can lead to suspiciousness and reluctance to participate. CONCLUSIONS: Our findings suggest that those interested in developing church-based health programs in the Black community must be attuned to how the same factors can both facilitate and hinder a program's development.     

The characteristics of northern black churches with community health outreach programs.

OBJECTIVES. The Black church has a long history of addressing unmet health and human service needs, yet few studies have examined characteristics of churches involved in health promotion. METHODS. Data obtained from a survey of 635 Black churches in the northern United States were examined. Univariate and multivariate statistical procedures identified eight characteristics associated with community health outreach programs: congregation size, denomination, church age, economic class of membership, ownership of church, number of paid clergy, presence of other paid staff, and education level of the minister. RESULTS. A logistic regression model identified church size and educational level of the minister as the strongest predictors of church-sponsored community health outreach. The model correctly classified 88% of churches that conduct outreach programs. Overall, the model correctly classified 76% of churches in the sample. CONCLUSIONS. Results may be used by public health professionals and policy makers to enlist Black churches as an integral component for delivery of health promotion and disease prevention services needed to achieve the Year 2000 health objectives for all Americans.     

Peer Reviewed: Using the RE-AIM Framework to Evaluate a Physical Activity Intervention in Churches

Introduction

Health-e-AME was a 3-year intervention designed to promote physical activity at African Methodist Episcopal churches across South Carolina. It is based on a community-participation model designed to disseminate interventions through trained volunteer health directors.

Methods

We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate this intervention through interviews with 50 health directors.

Results

Eighty percent of the churches that had a health director trained during the first year of the intervention and 52% of churches that had a health director trained during the second year adopted at least one component of the intervention. Lack of motivation or commitment from the congregation was the most common barrier to adoption. Intervention activities reached middle-aged women mainly. The intervention was moderately well implemented, and adherence to its principles was adequate. Maintenance analyses showed that individual participants in the intervention''s physical activity components continued their participation as long as the church offered them, but churches had difficulties continuing to offer physical activity sessions. The effectiveness analysis showed that the intervention produced promising, but not significant, trends in levels of physical activity.

Conclusion

Our use of the RE-AIM framework to evaluate this intervention serves as a model for a comprehensive evaluation of the health effects of community programs to promote health.     

Alternative mental health services: the role of the black church in the South

OBJECTIVES: This study determined the extent to which churches in the South were providing mental health and social services to congregations and had established linkages with formal systems of care. METHODS: A computer-assisted telephone interview (CATI) survey was conducted with pastors from 269 Southern churches. RESULTS: Black churches reported providing many more services than did White churches, regardless of urban or rural location. Few links between churches and formal provider systems were found, irrespective of the location--urban or rural--or racial composition of the churches. CONCLUSIONS: Results are discussed in terms of the potential for linking faith communities and formal systems of care, given the centrality of the Black church in historical context.     

Homophobia, hypermasculinity and the US black church

Black churches in the USA constitute a significant source of the homophobia that pervades black communities. This theologically-driven homophobia is reinforced by the anti-homosexual rhetoric of black nationalism. Drawing on a variety of sources, this paper discusses the sources of homophobia within black communities, and its impact upon self-esteem, social relationships and physical health. Religion-based homophobia and black nationalism point to wider structures which have influenced their emergence, including racism, patriarchy and capitalism. It is vital for US black churches and communities to understand and transcend their longstanding resistance to openly addressing complex, painful issues of sexuality and embrace healthier definitions of black manhood.     

Training volunteers to conduct heart health programs in churches

With cardiovascular disease the leading cause of death and disability in the United States, economically feasible and effective methods of prevention are needed. The Health and Religion Project (HARP) uses volunteers to provide cardiovascular risk-factor change programs to individuals in their church communities. The rationale for the use of volunteers in this setting is described, along with the design and initial response to the HARP volunteer training program. Two hundred twenty-two volunteers were certified across 16 study churches to conduct risk-factor change programs. Their certification exam performance demonstrated that they had mastered the knowledge and skills deemed necessary for their jobs. Overall, the trainees were very enthusiastic about their new roles. Based on this initial response, our partnership with churches for health promotion is worthy of further development.     

Divine targets: youth at the centre of Catholic and Pentecostal responses to HIV and AIDS in Brazil

This study explored the focus on youth in Catholic and Evangelical Pentecostal discussions about and responses to HIV and AIDS in Brazil. Key informant, oral history and in-depth interviews revealed a disconnect between young people's views of themselves as leaders in their religious institutions' responses to HIV and other social problems, and adult religious leaders' views of young people as vulnerable and in need of being 'saved'. Religious leaders presented young people as institutional commodities, emphasizing their symbolic value as signs of the health and future of their churches. We explore the unofficial exchange between religious institutions and young people, who benefited from the leadership opportunities and communities provided by their churches and youth groups. We discuss the political economy of youth in religious institutions' responses to HIV and AIDS within the context of Brazil's high levels of religious mobility as well as the broader, global commodification of spirituality and religion.     

The role of the Black Church in the lives of young Black men who have sex with men

In the USA, the Black Church is among the most important institutions in the Black community, offering numerous spiritual, social and health benefits. Yet, the presence of homonegativity in many Black Churches may mitigate those effects for gay Black youth. This research examines the role of the Church in the lives of gay and bisexual Black youth to understand how they reconcile any tension between their religious and sexual identities. Through interviews with pastors of Black churches (n = 21) and young Black men who have sex with men (n = 30), we explored homonegativity and young men’s experiences within the Black Church. Findings reveal that despite the prevalence of homonegativity within Black churches, religious involvement remains important for young men and many remain involved in non-affirming churches. The importance of the Church for young men stems from their significant involvement as youth and the integration of religion, family and community. Young men may not be able to leave their religious homes as readily as other gay youth given the cultural relevance of the Church. As a result, young men made attempts to conceal their sexuality in church to avoid shame and gossip and find opportunities to balance their sexuality and religiosity.     

Identifying churches for community-based mammography promotion: lessons from the LAMP study.

There is great potential in public health and faith communities partnering to promote health education and research. This article describes lessons learned from the design and implementation of such a partnership, the Los Angeles Mammography Promotion in Churches Program (LAMP). It is feasible, although challenging, to enumerate and survey churches in a geographically defined urban population, using data compiled from telephone directories, religious sources (e.g., denominational networks), chambers of commerce, and newspapers. Among those sources, telephone directories provided the broadest coverage, whereas religious sources yielded the highest recruitment rate. For collecting survey data from churches, telephone methods are superior to mail methods. For church-based health education programs that seek comprehensive coverage and have adequate resources, it is recommended that telephone directories be combined with religious sources to identify target churches. For programs with limited resources and less emphasis on comprehensive coverage, using religious sources alone is recommended.     

‘Church hurt can be the worst hurt’: community stakeholder perceptions of the role of Black churches in HIV prevention among young Black gay and bisexual men

Black gay and bisexual men aged 15–29 are disproportionately represented among new cases of HIV in the USA. Researchers have argued that community-based prevention cannot succeed without the participation of faith-based organisations, particularly given the salience of religion and spirituality in the lives of young Black gay and bisexual men. Yet some Black churches may be hesitant to engage in HIV prevention efforts given their beliefs about same-sex behaviour. It is less clear, however, whether and how public health practitioners in the field of HIV prevention have approached church inclusion. We therefore explored how community stakeholders describe the involvement of Black churches with the HIV continuum of care. We draw on a qualitative dataset of 50 in-depth semi-structured interviews conducted in Detroit, USA. Participants offered multiple perspectives on the response of Black churches to the HIV epidemic, from overt stigma to gradual acceptance and action. Nevertheless, participants agreed that when stigma was present in the pews and the pulpit, young Black gay and bisexual men were at potential risk of social isolation. Furthermore, tensions may exist between Black churches and secular community-based organisations that are attributable to histories of mistrust. These findings have important implications for future community-based intervention strategies among young Black gay and bisexual men.     

Cardiovascular disease prevention in Ghana: feasibility of a faith-based organizational approach

ObjectiveTo examine the feasibility of using community health workers (CHWs) to implement cardiovascular disease (CVD) prevention programmes within faith-based organizations in Accra, Ghana.MethodsFaith-based organization capacity, human resources, health programme sustainability/barriers and community members’ knowledge were evaluated. Data on these aspects were gathered through a mixed method design consisting of in-depth interviews and focus groups with 25 church leaders and health committee members from five churches, and of a survey of 167 adult congregants from two churches.FindingsThe delivery of a CVD prevention programme in faith-based organizations by CHWs is feasible. Many faith-based organizations already provide health programmes for congregants and involve non-health professionals in their health-care activities, and most congregants have a basic knowledge of CVD. Yet despite the feasibility of the proposed approach to CVD prevention through faith-based organizations, sociocultural and health-care barriers such as poverty, limited human and economic resources and limited access to health care could hinder programme implementation.ConclusionThe barriers to implementation identified in this study need to be considered when defining CVD prevention programme policy and planning.     

Divine targets: youth at the centre of Catholic and Pentecostal responses to HIV and AIDS in Brazil

This study explored the focus on youth in Catholic and Evangelical Pentecostal discussions about and responses to HIV and AIDS in Brazil. Key informant, oral history and in-depth interviews revealed a disconnect between young people's views of themselves as leaders in their religious institutions' responses to HIV and other social problems, and adult religious leaders' views of young people as vulnerable and in need of being ‘saved’. Religious leaders presented young people as institutional commodities, emphasizing their symbolic value as signs of the health and future of their churches. We explore the unofficial exchange between religious institutions and young people, who benefited from the leadership opportunities and communities provided by their churches and youth groups. We discuss the political economy of youth in religious institutions' responses to HIV and AIDS within the context of Brazil's high levels of religious mobility as well as the broader, global commodification of spirituality and religion.     

Perceptions of the religion-health connection among African American church members

In this qualitative study, the authors examine perceptions of the religiosity-health connection among African American church members. They conducted 33 interviews with members of predominately African American churches. The clergy and members from each congregation completed semistructured interviews. Participants described the religiosity-health connection in their own words and talked about whether and how their religious beliefs and practices affect their health. The authors derived an open coding scheme from the data using an inductive process. Themes that emerged spontaneously and consistently included but were not limited to spiritual health, mental health's effects on physical health, importance of the church family, giving problems up to God, and the body as a temple of God. These religion-health themes might hold promise for integration into church-based health promotion interventions for this population.     

Examining Church Capacity to Develop and Disseminate a Religiously Appropriate HIV Tool Kit with African American Churches

Increasingly, African American churches have been called upon to assist in efforts to address HIV/AIDS in underserved communities. African Americans churches may be well-positioned to provide HIV education, screening, and support services, particularly if they are equipped with church-appropriate, easy-to-deliver HIV tools that can be implemented through the naturalistic church environment. To inform the development of a church-based HIV tool kit, we examined church capacity with African American church leaders (N = 124 participants; n = 58 churches represented by senior pastors). Nearly all participants (96%) wanted to learn more about HIV and how to discuss it with their parishioners. Regarding church capacity, most of their representative churches held three regular services each week, facilitated various inreach and community outreach ministries, and had paid staff and computers. Also, many of their churches facilitated HIV/AIDS education/prevention and adolescent sex education activities. Guided by church capacity findings, an ecological framework, and a CBPR approach, we describe the resulting church-based HIV Tool Kit that “fits” naturalistically within a multilevel church infrastructure, builds upon churches'' HIV-related experience, and equips faith leaders to efficiently promote HIV services with the communities they serve.     

Correlates of Perceived Risk of Developing Cancer Among African-Americans in South Los Angeles

There are differences in cancer-risk perception among racial/ethnic groups that may affect health risk behaviors. Using a community partnered-participatory research approach, we conducted a survey on cancer screening, risk behaviors, and related knowledge/attitudes within 11 churches in South Los Angeles with predominantly African-American parishioners. This analysis examines correlates of perceived risk of developing cancer among 755 African American adults. Almost 15 % of participants indicated higher perceived risk for cancer compared to the average man/woman of the same age, 38 % indicated same risk, whereas 48 % perceived lower risk. Sixty-nine individuals (9 %) reported a cancer history and 63 % reported at least one blood relative with cancer. Controlling for demographic characteristics and healthcare access, participants who reported higher risk of cancer had higher level of cancer-related knowledge; were current and ex-smokers; had poorer health status; had a blood relative with cancer; had a cancer history; and had discussed their risk of cancer with their doctor. The bivariate association between high perceived cancer risk and lack of exercise and obesity disappeared after adjusting for demographic characteristics and perceived health status. Our data suggest that a substantial proportion of African Americans in South Los Angeles may underestimate their cancer risk. Additionally, lack of exercise and obesity are not recognized as independent cancer risk factors as much as smoking and personal and family history of cancer. Next steps will be to inform participating churches about our findings and explore their interest in taking steps to reduce health risk behaviors among their parishioners.