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 HIV Testing among African American and Latino Church Congregants: The Role of HIV Stigmatizing Attitudes and Discussions about HIV

Faith-based organizations can be key settings in which to reach African Americans and Latinos for HIV prevention, but little is known regarding factors that predict congregants’ HIV testing behaviors. We examined the extent to which sociodemographic factors, HIV-related cues to action (e.g., knowing someone who is HIV-positive), and the social climate surrounding HIV (stigma toward a hypothetical HIV-positive congregant, HIV-related discussions at church about abstinence, condoms, and testing) were associated with willingness to be tested in church and with ever having been tested among 1211 African American and Latino congregants. Multivariate analyses indicated that congregants were more open to church-based testing if they were younger and had discussed condoms at church. They were less open if they expressed stigmatizing attitudes toward a hypothetical congregant. Foreign-born Latinos with low English proficiency were more willing to be tested at church than were African Americans. Congregants were more likely to have ever been tested if they were younger, African American, female, or married; if they knew someone who was HIV-positive; and if they had discussed testing and condoms at church. They were less likely if they had discussed abstinence. Open dialogue around HIV may activate congregants to be more receptive to church-based prevention.     

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.     

The North Carolina Black Churches United for Better Health Project: intervention and process evaluation.

The North Carolina Black Churches United for Better Health project was a 4-year intervention trial that successfully increased fruit and vegetable (F&V) consumption among rural African American adults, for cancer and chronic disease prevention. The multicomponent intervention was based on an ecological model of change. A process evaluation that included participant surveys, church reports, and qualitative interviews was conducted to assess exposure to, and relative impact of, interventions. Participants were 1,198 members of 24 intervention churches who responded to the 2-year follow-up survey. In addition, reports and interviews were obtained from 23 and 22 churches, respectively. Serving more F&V at church functions was the most frequently reported activity and had the highest perceived impact, followed by the personalized tailored bulletins, pastor sermons, and printed materials. Women, older individuals, and members of smaller churches reported higher impact of certain activities. Exposure to interventions was associated with greater F&V intake. A major limitation was reliance on church volunteers to collect process data.     

Efficacy of an HIV/STI Sexual Risk-Reduction Intervention for African American Adolescent Girls in Juvenile Detention Centers: A Randomized Controlled Trial

Few HIV/STI interventions exist for African American adolescent girls in juvenile detention. The objective was to evaluate the efficacy of an intervention to reduce incident STIs, improve HIV-preventive behaviors, and enhance psychosocial outcomes. We conducted a randomized controlled trial among African American adolescent girls (13–17 years, N = 188) in juvenile detention from March 2011 to May 2012. Assessments occurred at baseline and 3- and 6-months post-randomization and included: audio computer-assisted self-interview, condom skills assessment, and self-collected vaginal swab to detect Chlamydia and gonorrhea. The Imara intervention included three individual-level sessions and four phone sessions; expedited partner therapy was offered to STI-positive adolescents. The comparison group received the usual care provided by the detention center: STI testing, treatment, and counseling. At the 6-month assessment (3-months post-intervention), Imara participants reported higher condom use self-efficacy (p < 0.001), HIV/STI knowledge (p < 0.001), and condom use skills (p < 0.001) compared to control participants. No significant differences were observed between trial conditions in incident Chlamydia or gonorrhea infections, condom use, or number of vaginal sex partners. Imara for detained African American adolescent girls can improve condom use skills and psychosocial outcomes; however, a critical need for interventions to reduce sexual risk remains.     

A church-based physical activity intervention for African American women

This trial evaluated a 6-month, church-based aerobic exercise intervention to increase physical activity among African American women relative to a health lecture and stretching condition. Participants were 196 women from 11 churches. Churches were randomized to an Aerobic Exercise or Health N Stretch intervention. Results indicated that physical activity was not different in Aerobic Exercise and Stretch N Health, although attendance in both interventions was low. Both groups reduced physical inactivity prevalence from baseline (26% and 18% decline, respectively). Higher baseline social support predicted change in physical activity, regardless of treatment assignment. Researchers must continue to work to identify successful intervention strategies to increase physical activity in African American women who are at disproportionate risk of chronic diseases associated with physical inactivity.     

Design of a faith-based HIV intervention: successful collaboration between a university and a church

This article describes the development of a gender-specific and culturally tailored, theoretically derived, faith-based HIV intervention created to reduce HIV vulnerability among African American women. This innovative culturally congruent approach to HIV prevention involves one of the most influential social structures in the African American community-the African American church. Using the ADAPT-ITT model, and principles of community-based participatory research, this faith-based HIV intervention was adapted from a CDC-defined evidence-based HIV prevention intervention for young African American women. Results of data assessing the feasibility of implementing this faith-based HIV intervention suggests that young African American women are receptive and willing to participate in a faith-based HIV intervention. Results show that fidelity to intervention implementation (97%) and participant attendance to both sessions (92%) was high, and the HIV risk behaviors targeted in the faith-based intervention matched the participants' HIV behavioral risk profile. Given the vulnerability of young African American women to HIV sustainable efforts, in particular, the institutionalization of this intervention within the church structure could halt the persistent increase in HIV infections within this community.     

Assessing the Health Attitudes, Beliefs, and Behaviors of African Americans Attending Church: A Comparison from Two Communities

Public health officials and researchers continue to be increasingly concerned about the health of populations of color, especially African Americans. A survey was administered in African American churches in two communities (Wichita, KS and Tuscaloosa, AL) to gather information concerning health behaviors and beliefs and to design interventions that might improve their health status. The study examined the homogeneity of attitudes, beliefs, and behaviors across these samples and to determine the readiness to change using the Transtheoritical Model. Individuals completed a 33-item survey: 6 demographic questions, 12 health behavior questions, 8 health belief questions, 3 church attendance questions, and 4 church-based health promotion program questions. The total sample consisted of 429 respondents. The results showed that 93% of respondents have had their blood pressure checked in the past 2 years. While only 44% indicated eating a high fiber diet during the week. Thirty percent of respondents indicated that their health was dependent on fate or destiny. The findings from this study confirm that among both samples that health attitudes, beliefs, and behaviors need to be changed to lower the risk of certain diseases and disorders. The findings also indicate that both samples have similar beliefs about health that may have important implications for disseminating information to the community. Innovative and culturally sensitive programs are needed in the African American community if disparities in health are to diminish.     

Church-based telephone mammography counseling with peer counselors

Little is published about step-by-step implementation of telephone counseling interventions to promote community-based health activities. This article describes the authors' experience of implementing a church-based telephone mammography counseling intervention with peer counselors representing three principal racial or ethnic groups: African American, Latino, and Anglo (White). Twenty-six women from 12 churches in the Los Angeles area were recruited and trained to deliver the counseling annually over a two-year period to 570 women participants who were recruited from participating churches (n = 15). The counseling sessions were conducted from church-based telephone centers in key geographic locations in our program area. Training and supervision proved challenging: most of the Latino counselors had fewer than seven years of education and spoke only Spanish, while most of the other counselors had at least some college and spoke only English. Culturally specific and small group interactions, role plays, and a more modular approach to training were the most effective ways to enhance counselors' skills. Latina participants' mammography adherence rates were lowest, and their barriers reflected their low socioeconomic status; as Latina counselors shared basic information about mammograms and where to obtain them at little or no cost, the counseling exchanges tended to be nonconflictive and supportive. Black and White participants were generally more knowledgeable and adherent with screening guidelines than Latinas. We found that it was possible to implement this intervention with diverse groups and conclude with lessons learned that may inform others considering such a strategy.     

Dealing with diversity: recruiting churches and women for a randomized trial of mammography promotion.

There is little documentation about the recruitment process for church-based health education programs. In this study, the authors recruit African American, Latino, and white churches and women members (age 50 to 80) for a randomized church-based trial of mammography promotion in Los Angeles County. Efforts to enhance recruitment began 10 months before churches were invited to participate and included a variety of community-based strategies. Subsequently, 45 churches were recruited over a 5-month period through group pastor breakfast meetings and church-specific follow-up. In close collaboration with the 45 churches, the authors administered church-based surveys over 6 months and identified 1,967 age-eligible women who agreed to be contacted by the program team. It was found that an extended resource intensive period of relationship-building and community-based activities were necessary to conduct church-based programs effectively, particularly among older and ethnically diverse urban populations.     

Ministers’ Perceptions of Church-Based Programs to Provide Depression Care for African Americans

African Americans, compared with white Americans, underutilize mental health services for major depressive disorder. Church-based programs are effective in reducing racial disparities in health; however, the literature on church-based programs for depression is limited. The purpose of this study was to explore ministers’ perceptions about depression and the feasibility of utilizing the church to implement evidence-based assessments and psychotherapy for depression. From August 2011 to March 2012, data were collected from three focus groups conducted with adult ministers (n = 21) from a black mega-church in New York City. Using consensual qualitative research to analyze data, eight main domains emerged: definition of depression, identification of depression, causal factors, perceived responsibilities, limitations, assessment, group interpersonal psychotherapy, and stigma. A major finding was that ministers described depression within a context of vast suffering due to socioeconomic inequalities (e.g., financial strain and unstable housing) in many African American communities. Implementing evidence-based assessments and psychotherapy in a church was deemed feasible if principles of community-based participatory research were utilized and safeguards to protect participants’ confidentiality were employed. In conclusion, ministers were enthusiastic about the possibility of implementing church-based programs for depression care and emphasized partnering with academic researchers throughout the implementation process. More research is needed to identify effective, multidisciplinary interventions that address social inequalities which contribute to racial disparities in depression treatment.     

The SISTA Pilot Project: Understanding the Training and Technical Assistance Needs of Community-Based Organizations Implementing HIV Prevention Interventions for African American Women-Implications for a Capacity Building Strategy

ABSTRACT

The disproportionate rates of HIV/AIDS among African American women in the U.S. signify the ongoing need for targeted HIV prevention interventions. Additionally, building the capacity of service providers to sustain prevention efforts is a major concern. The Centers for Disease Control and Prevention (CDC) conducted a pilot project to disseminate the Sisters Informing Sisters about Topics on AIDS (SISTA), an HIV prevention intervention designed for African American women. The project was to inform the diffusion process and examine the training and technical assistance needs of participating community-based organizations. Results demonstrated a need for extensive pre-planning and skills-building prior to implementation.     

Reaching and Supporting At-Risk Community Based Seniors: Results of a Multi-church Partnership

The purpose of this study was to determine the impact of a nurse-led, church-based educational support group for “at-risk,” older African Americans on hospitalization and emergency department use. Study nurses enrolled 81 “at-risk” older adult members of ten churches. Participants completed a trifold pamphlet identifying personal health information and support, and they attended eight monthly educational/support group sessions in their church during the 10-month intervention. Study nurses completed a risk assessment interview with each senior both pre- and post-participation. The study nurse completed post-program assessments with 64 seniors, a 79% retention rate. At the program’s conclusion researchers conducted a focus group with the study RNs and used an anonymous written survey to gather participant appraisals of program elements. Neither hospitalization nor emergency department/urgent care usage was significantly different from pre- to post-program. Session attendance was moderate to high and over half of the seniors brought a family member or friend to one or more sessions. The majority of seniors initiated positive health changes (e.g., smoking cessation, weight loss, or diet changes). Participants expressed high satisfaction and expressed satisfaction to perceive that they were supporting other seniors in their community. We conclude that this intervention was successful in engaging and motivating seniors to initiate health behavior change and contributed to a health-supportive church-based community. To demonstrate a statistically significant difference in hospital and ED usage, however, a stronger intervention or a larger sample size is needed.     

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.     

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

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

Frailty, family, and church support among urban African American elderly

A community-based survey of 507 African Americans aged 60 and older from South Central Los Angeles was conducted to estimate the prevalence of frailty and describe the correlation between frailty, social support from family and church, and use of community services. Persons were considered frail if they met criteria for any of four conditions: functional impairment, depression, urinary incontinence, falls. Sixty-seven percent met criteria for frailty. Analyses revealed that frail elderly were significantly less likely to report feeling very close to family. Family contact, feeling that church was important, and receiving church support were similar for the frail and nonfrail. Frail elderly were more likely to use community services. These findings suggest that frail elderly in this population may not receive more support from family and church than nonfrail elderly. There is a need for caution when assuming families and churches in urban African American communities are able to support the most vulnerable elderly.     

Recommendations From a Research Consultation to Address Intervention Strategies for HIV/AIDS Prevention Focused on African Americans

Despite substantial federal resources spent on HIV prevention, research, treatment, and care, as well as the availability and dissemination of evidence-based behavioral interventions, the disparate impact of HIV on African Americans continues.In October 2007, 3 federal agencies convened 20 HIV/AIDS prevention researchers and care providers for a research consultation to focus on new intervention strategies and current effective intervention strategies that should be more widely disseminated to address the HIV/AIDS epidemic among African Americans.The consultants focused on 2 areas: (1) potential directions for HIV prevention interventions, defined to include behavioral, community, testing, service delivery, structural, biomedical, and other interventions; and (2) improved research methods and agency procedures to better support prevention research focused on African American communities.IN THE UNITED STATES, African Americans are the racial group most affected by HIV/AIDS. Although comprising approximately 13% of the US population, at the end of 2007 African Americans accounted for 46% of the estimated 1.1 million cases of HIV or AIDS, including 60% of cases among women.^1,2 Of the adult and adolescent HIV/AIDS cases reported during 2007, 47% were among African Americans, and new HIV incidence estimates indicate that 45% of new HIV cases in 2006 were among African Americans.^2,3 For African American men, the leading cause of infection is men having sex with other men, and for women the leading transmission route is heterosexual sex.^1,2Meta-analyses show that behavioral interventions are efficacious in reducing HIV risk behaviors and rates of sexually transmitted infections among heterosexually active African Americans,⁴ African American women,⁵ and African American and Hispanic patients in sexually transmitted disease clinics.⁶ In December 2008, the Centers for Disease Control and Prevention (CDC) released the 2008 Compendium of Evidence-Based HIV Prevention Interventions,⁷ which identifies 57 individual and group-level evidence-based interventions, including many such interventions for African Americans. A number of these evidence-based interventions, as well as additional community-level interventions, have been packaged⁸ and disseminated⁹ to a variety of community-based organizations, health departments, and HIV clinics.Despite the substantial resources spent by federal agencies on HIV prevention, research, treatment, and care, as well as the availability and dissemination of evidence-based behavioral interventions, the disproportionate impact of HIV on the African American community continues. Issues may include inadequate scale (e.g., more resources are needed for broader dissemination of evidence-based interventions), implementation challenges, and the need for stronger or different types of interventions. On October 17 and 18, 2007, the CDC, the National Institutes of Health (NIH), and the Health Resources and Services Administration (HRSA) convened a collaborative research consultation in Atlanta, Georgia, to discuss novel intervention strategies (with a focus on new intervention strategies and current effective intervention strategies that should be more widely disseminated) to address the HIV/AIDS epidemic among African Americans. Twenty consultants attended; these were primarily HIV/AIDS prevention researchers and providers who had experience in conducting research on determinants of health disparities or in developing, implementing, and evaluating HIV/AIDS prevention interventions targeting African Americans.The discussion focused on 2 areas: (1) future directions for HIV prevention interventions for African Americans, defined to include behavioral, community-level, testing, service delivery, structural, biomedical, and other interventions; and (2) improved research methods and agency procedures to better support prevention research focused on African American communities. The consultants were divided into 3 groups that focused on 3 populations—adult heterosexuals, youths, and men who have sex with men and men who have sex with men and women. Cross-cutting issues such as substance abuse and incarceration were discussed in each group. All consultants then reconvened as a large group, and recommendations from each group were presented and discussed with an eye toward advising agencies on future HIV/AIDS prevention research initiatives targeting African Americans.We summarize the recommendations from the consultation. Many of the recommendations were common across the 3 subpopulations, so the recommendations are provided around the 2 main areas of focus—namely, directions for HIV prevention interventions and research methods and support needed for HIV prevention research with African American communities.     

‘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.     

Understanding physical activity participation in members of an African American church: a qualitative study

Faith-based interventions hold promise for increasing physical activity (PA) and thereby reducing health disparities. This paper examines the perceived influences on PA participation, the link between spirituality and health behaviors and the role of the church in promoting PA in African Americans. Participants (n = 44) were adult members of African American churches in South Carolina. In preparation for a faith-based intervention, eight focus groups were conducted with sedentary or underactive participants. Groups were stratified by age (<55 years versus >or=55 years), geography and gender. Four general categories were determined from the focus groups: spirituality, barriers, enablers and desired PA programs. Personal, social, community and environmental barriers and enablers were described by both men and women, with no apparent differences by age. Additionally, both men and women mentioned aerobics, walking programs, sports and classes specifically for older adults as PA programs they would like available at church. This study provides useful information for understanding the attitudes and experiences with exercise among African Americans, and provides a foundation for promoting PA through interventions with this population by incorporating spirituality, culturally specific activities and social support within the church.