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Networking Between Agencies and Black Churches
Abstract
The question of the possible, proper, or desirable relationships of churches lo health and human service agencies is raised. Identifying, recruiting, and training important members of natural helping networks in the black church, who can serve as “lay health advisors” (LHA) linking and negotiating between people at risk and agency services, is one health intervention strategy for establishing a relationship between formal and informal support systems. As lay people to whom others naturally turn for advice, emotional support, and tangible aid, LHAs provide informal and spontaneous assistance. Found at many levels in a community, these persons are already helping people by virtue of their community roles, occupations, or personality traits. A lay health advisor intervention model conceptualizes the relationships between the social support functions of networks within black congregations and their expected effects on: (1) the behaviors of individuals at risk; (2) the service delivery structures of agencies; and (3) the problem solving capacities of communities. Based on this model, three types of LHA interventions are categorized in accordance with the aim of network member involvement: (1) enhancing the total network within a church; (2) cooperative problem-solving linking networks between churches; and (3) coalition building connecting networks beyond the church. An intervention example for each of these categories is provided, including a description of the target population, support provider), purpose, problems addressed, network characteristics emphasized, activities used, and role of the professional. Important lessons learned from these examples are drawn, with particular emphasis given to the issues and special interests of working with natural helping networks in black congregations.
... Because economic conditions faced by pastors and church leaders in rural communities usually reflect to some degree the economic conditions of church members, they are frequently aware of community issues (i.e., poverty, medical and mental health issues, and incarceration) and can oversee the needs of community constituents of the interorganizational alliance (Lewis & Trulear, 2008). These can be employed to identify key individuals within the community who can provide informational, as well as emotional and tangible support, to collaborative members (Eng & Hatch, 1991). ...
... An example of a single service site is provided by Eng and Hatch (1991) who developed one of the most notable rural church sponsored programs, collaborating with area service agencies to use rural churches in North Carolina as a focus for health promotion activities. Eng, Hatch, and Callan (1985) documented the development and impact of church health care programs in which pastors asked congregants to identify people within the congregation who could serve as health advisors. ...
... Among other successes [14], CHA programs have successfully addressed health concerns [15][16][17][18][19][20] and chronic diseases, including CVD [21,22], hypertension [13,23], diabetes [24] and cancer [25][26][27][28]. CHAs can facilitate the adoption of health promotion programs by acting as change agents and opinion leaders with shared language, culture and values and extensive knowledge of local resources and health issues [29][30][31][32][33]. One approach, the Community Health Advisor Network (CHAN) model [30,34], involves recruiting and training a community's natural helpers (those to whom community members already turn for support and advice) to enhance knowledge and skills required to address their community's needs. ...
... The Uniontown Project is unique in that it integrated training in CVD risk reduction with the traditional CHA focus on general community issues, and it combined the grassroots CHA model with the CHC, a coalition of local leaders. Although previous studies have used lay helper models to address other health issues in rural women [30,31] and to address single and multiple CVD risk factors in Community Health Advisor Program for CVD risk urban African-American populations [13,[21][22][23][24]45], no other published studies have reported on a program targeting multiple CVD risk factors in rural African-American women, and none has documented wide-reaching changes in community capacity to address health issues beyond the scope of the original project. This is also the first documentation that CHAs working in the context of a chronic disease intervention project can lead efforts to improve a community's physical infrastructure. ...
The Uniontown, Alabama Community Health Project trained and facilitated Community Health Advisors (CHAs) in conducting a theory-based intervention designed to reduce the risk for cardiovascular disease (CVD) among rural African-American women. The multiphased project included formative evaluation and community organization, CHA recruitment and training, community intervention and maintenance. Formative data collected to develop the training, intervention and evaluation methods and materials indicated the need for programs to increase knowledge, skills and resources for changing behaviors that increase the risk of CVD. CHAs worked in partnership with staff to develop, implement, evaluate and maintain strategies to reduce risk for CVD in women and to influence city officials, business owners and community coalitions to facilitate project activities. Process data documented sustained increases in social capital and community capacity to address health-related issues, as well as improvements in the community's physical infrastructure. This project is unique in that it documents that a comprehensive CHA-based intervention for CVD can facilitate wide-reaching changes in capacity to address health issues in a rural community that include improvements in community infrastructure and are sustained beyond the scope of the originally funded intervention.
... Religious organizations (mosques and churches etc.) are known in the social capital literature as creators and facilitators of social capital. Churches have a history of volunteerism (Wuthnow, 1991), advocate teachings of care and love for others (Park & Smith, 2000), and play a dominant role in many communities (Eng et al., 1985;Eng & Hatch, 1991). This may facilitate the production of social capital, not only within the religious organizations but also outside of the church into the larger community. ...
AUTHORS This paper aims to examine the relationship between religiosity, social capital, and the subjective well-being of individuals in Pakistan. Subjective well-being can be observed in self-reported health, happiness, and life satisfaction. By using Partial Least Square Structural Equation Modeling (PLS-SEM) on the data for Pakistan, taken from the seventh wave of the World Value Survey (WVS-7), the results reveal that religion and social capital contribute to an individual's well-being. Subjective well-being increases for those who are more active in religious associations. Social capital has a significant positive impact on subjective well-being.
... Pastors and church leaders can serve as highly credible role models and persuaders in encouraging healthy behaviors through sermons, organized activities and personal example. [35][36][37][38][39][40][41] Working in partnership with churches, health promotion efforts can be promoted and sustained by incorporating the natural assets of the social, organizational and religious aspects of the church into behavior change programs. ...
African-American men have the highest prostate cancer rates worldwide, and innovative efforts are needed to increase cancer prevention and screening behaviors
among this population. Formative research was conducted to assess attitudes and behaviors linked to prostate cancer prevention activities that could be used to develop a culturally relevant intervention for an African-American church-based population. Four gender-specific focus groups wereconducted with 29 men and women at two African-American churches in central North Carolina. Three primary themes emerged from the focus group discussions: culturally and gender-influenced beliefs and barriers about cancer prevention and screening; barriers related to the healthcare
system; and religious influences, including the importance of spiritual beliefs and church support.
These discussions revealed the importance of the black family, the positive influence of spouses/partners on promoting cancer screening and healthy behaviors, the roles of faith and church leadership, and beliefs about God's will for good health. These findings also revealed that there are still major barriers and challenges to cancer prevention among African Americans, including continued mistrust of the medical community and negative attitudes toward specific screening tests. Findings provide important insights to consider in implementing successful prostate cancer prevention interventions designed for church-based audiences.
... First, the program assists in building the capacity of each FBO by identifying current members who are interested in participating in a health minister certificate program. This use of a peer-to-peer approach is grounded in the notion that a shared cultural background between health ministers and congregation members facilitates greater credibility and understanding in the delivery of interventions, while also building capacity within the organization itself (Eng & Hatch, 1991;Eng & Young, 1992). Second, Faithfully Fit will assist these newly certified health ministers in delivering health promotion programs that serve the needs of each congregation and are more sustainable over the long-term. ...
This article describes capacity building and formative assessments completed at five faith-based organizations (FBOs) in Washington, DC to inform sustainable health promotion programming led by certified health ministers. Five FBO partners were recruited with two congregation members from each FBO completing a health minister certificate program. A series of health assessments were conducted to assess each FBO’s capacity to implement evidence-based lifestyle change programs that are responsive to congregation members’ health needs. Results indicated a need for programming to support older adults in managing high blood pressure and arthritis. Health ministers represent a significant opportunity for building capacity within FBOs to deliver programming that can improve health outcomes.
... Churches have a robust history of developing and implementing programs to address the needs of vulnerable children (Eng & Hatch, 1991;Markens, Fox, Taub, & Gilbert, 2002;Moore, 1991;Taylor, Ellison, Chatters, Levin, & Lincoln, 2000). From early settlement houses to the nation's first advocates for child welfare policies, churches, and their members, have been at the forefront of services and supports to vulnerable children (Gowan, 2014). ...
A child who has a parent incarcerated is likely to experience a number of life challenges including school failure, poverty, substance abuse, and justice system involvement. The negative outcomes associated with having a parent incarcerated disproportionately expose children to adverse childhood events (ACE's) which have been associated with higher morbidity and mortality. However, engagement with caring adults who can provide both practical and spiritual mentorship can increase a child's resilience and buffer the impact of these negative outcomes. Church-based mentors have the capacity to provide support to this population when adequately trained in trauma-informed responses. This study describes Camp Agape California (CAC), a church-based mentoring program for children with an incarcerated parent. Specifically, this study describes the development and implementation of a trauma focused mentorship training purposed to equip church members to better meet the needs of this vulnerable population. Seventy-six volunteer mentors from various churches participated in the training and completed the post-training survey. Results suggest that the trauma informed training was effective at increasing knowledge and self-efficacy and was identified as being relevant to the mentor role. Implications for the utility of church-based mentorship for vulnerable populations are explored.
... Secondly, due to their participation within the community, they possess a complex understanding of their community's history, its culture, local social norms, and local social networks of inhabitants, neighbors, and friends (Eng et al., 2002;Eng et al., 1997;Rhodes et al., 2007;. The promotora training intervenes at the individual level, as she gains knowledge and skills in a health topic, and she disseminates information, supports selfadvocacy, and links peers with local resources (Eng, 1991;Kaphingst et al., 2011). Adaptation of the model with Latino and migrant communities has resulted in promising interventions to reduce disparities in breast cancer, HIV, diabetes, cardiovascular disease, obesity, and smoking Cabassa et al., 2007;Cherrington et al., 2010;Elder et al., 2009;Martínez-Donate, 2009;Mcquiston et al., 2001;Saad-Harfouche et al., 2011). ...
Use of mental health care services for psychological distress is limited among Latino immigrants. In geographic areas where migration has been rapid, mental health systems possess limited capacity to provide bilingual and bicultural assistance. The development of a bilingual and bicultural workforce is a necessary yet long-term solution. More immediate strategies, however, are needed to meet the needs of immigrant Latinos. This paper describes the development of a stress-reduction focused, lay health advisor training that targets individual behavior change among Latina immigrants. The theoretical foundation, curriculum components, and pilot implementation of the training are discussed. As natural leaders, Latina promotoras disseminated learned strategies and resources within their communities. The lay health advisor model is a salient method for disseminating information regarding mental health and stress reduction among Latinas.
... Renewed investment in church-based HIV prevention is warranted, in which those involved have a deep understanding of both the objectives of HIV prevention and the traditions of Black churches (Eng and Hatch 1991). This study contributes to a growing literature illustrating the potential for faith-based prevention efforts to address rising incidence 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.
... There have also been antipoverty and material aid programs (Chaves & Higgins, 1992), programs for the elderly and their caregivers (Caldwell et al., 1995), and programs promoting general health (Eng & Hatch, 1991). Though a majority of African Americans identify with the Protestant tradition of Christianity, most Black people, regardless of church affiliation, recognize the role of the church in responding to the psychological, social, cultural, economic, educational, and political needs of the community (Cook, 1993;Taylor et al., 2004;Wiley, 1991 They have also facilitated relations between Black communities, social institutions, and organizations within a broader society (Taylor, Chatters, & Levin, 2004). ...
According to the National Institute of Mental Health (2008) nearly one-third of American adults experience a diagnosable mental disorder in any given year. Of those who experience mental illness only one in three will actually seek professional help (Obasi & Leong, 2009). This number becomes even smaller for people of African descent. African Americans are less likely to seek professional help for their personal problems (Cramer, 1999) because of barriers like inadequate health insurance and stigma. However, there are fewer challenges associated with African Americans seeking help from religious leaders (Chiang, Hunter, & Yeh, 2004). By their involvement in different communities, religious leaders are reasonably respected and trusted by many African Americans (Taylor, Chatters, & Levin, 2004). Therefore, many of their congregants may turn to them for help dealing with their personal issues. Religious leaders are presented with mental health concerns similar to that of counselors (Larson, 1988), but unlike counselors they may not recognize symptoms of serious mental illness (Farrel & Goebert, 2008). Consequentially, in addition to other factors, religious leaders may fail to make counseling referrals when appropriate. The purpose of this study was to explore the referral process religious leaders engage in at Black churches. The Clergy Referral Process Model was developed using the information the participants of this study provided. The themes that make up the Clergy Referral Process Model include: understanding self, discussing mental health, relationship with parishioners, including staff, arranging a meeting, assessing need, spirituality, referring, barriers, and follow-up. The model developed from this study provides a framework for understanding the referral process clergy in Black churches engage and it can be used to encourage clergy to begin making counseling referrals or increase the number of referrals being made.
Advisor: Michael J. Scheel
... Ruh sağlığı alanlarında çalıĢan psikologlar, aynı zamanda evsizlik, bedensel veya ruhsal hastalıklar gibi çeĢitli insanî sorunların iyileĢtirilmesinde din çalıĢanlarıyla iĢbirliği yapmaktadır (Cohen ve diğerleri, 1991;Eng & Hatch, 1991). Son on yılda yapılan araĢtırmalar da klinik psikolog ve psikoterapistlerin, eskiye oranla giderek daha fazla dine yöneldiklerini göstermektedir (Bergin & Jensen,1990;Jones,1994). ...
... The study was guided by the Lay Health Advisor model, Flaskerud and Winslow's vulnerable populations framework, and the Behavioral Model for Vulnerable populations [17][18][19]. These were integrated to be comprehensive of the multiple, inter-relating characteristics associated with the health, health behaviors, and health service utilization of vulnerable populations. ...
The problem of cancer health disparities is substantial. Clinical trials are widely advocated as a means of reducing disparities and bringing state-of-the-art care to the broader community, where most cancer care is delivered. This study sought to develop a better understanding of why disproportionately few African American men enroll in clinical trials given their substantial cancer burden.
This study applied community-based participatory research (CBPR) methods to design and conduct four focus groups of African American male cancer survivors and their caregivers in North Carolina.
Among major themes, participants expressed confusion about the relationship between clinical trials, treatment, and research, signifying patient confusion and misinterpretation of common clinical trial terminology. Social norms including gender barriers and generational differences remain problematic; participants often reported that men do not talk about health issues, are unwilling to go to the doctor, and exhibit misapprehension and distrust regarding trials. Participants perceived this as detrimental to community health and expressed the need for more clarity in clinical trials information and a more fundamental social openness and communication about cancer detection and treatment.
Findings indicate the importance of clinical trials education in both traditional provider referral to trials and also in general patient navigation. To dispel pervasive misapprehension regarding placebos, clinical trials information should emphasize the role of standard care in modern cancer treatment trials. Many participants described willingness to participate in a trial upon physician recommendation, suggesting merit in improving patient-physician communication through culturally competent terminology and trial referral systems.
... We chose a LHA model because it targets change at multiple levels, builds upon strong networks in rural African American communities, and is adaptable (Thomas, 2006;Wolff et al., 2004). LHAs are natural helpers with expertise and knowledge that enhance the health and competence of their community through information distribution, assistance, and organization of community building activities within their social networks (Eng & Hatch, 1991;Israel & Rounds, 1987;Plescia, Herrick, & Chavis, 2008). LHAs' ability to access and activate structures both internal and external to their social networks has been identified as an important resource for social change (e.g., Parker, Schulz, Israel, & Hollis, 1998). ...
This study evaluated the impact of the Teach One Reach One intervention, a community-based participatory research project designed to address the co-occurrence of adolescent risk behaviors on acceptance of teen dating violence. Data were derived from 331 rural African American youth between 10 and 14 years of age who participated in caregiver-youth dyads as either: (1) peer lay health advisor dyads, or Ambassadors, (2) caregiver-youth dyads recruited by Ambassadors, or Allies, or (3) comparison dyads. The following study focuses on participating youth only and our results indicated that: (1) Ambassadors and Allies reported less acceptance of couple violence than youth within the comparison group, and (2) less family cohesion, greater family conflict, and greater knowledge of healthy dating behaviors predicted greater acceptance of couple violence. Our findings highlight the efficaciousness of the TORO intervention, which directly engaged participants in prevention efforts through community-based participatory research methods and the use of lay heath advisors.
... Secondly, due to their participation within the community, they possess a complex understanding of their community's history, its culture, local social norms, and local social networks of inhabitants, neighbors, and friends (Eng et al., 2002;Eng et al., 1997;Rhodes et al., 2007;. The promotora training intervenes at the individual level, as she gains knowledge and skills in a health topic, and she disseminates information, supports selfadvocacy, and links peers with local resources (Eng, 1991;Kaphingst et al., 2011). Adaptation of the model with Latino and migrant communities has resulted in promising interventions to reduce disparities in breast cancer, HIV, diabetes, cardiovascular disease, obesity, and smoking Cabassa et al., 2007;Cherrington et al., 2010;Elder et al., 2009;Martínez-Donate, 2009;Mcquiston et al., 2001;Saad-Harfouche et al., 2011). ...
Use of mental health care services for psychological distress is limited among Latino immigrants. In geographic areas where migration has been rapid, mental health systems possess limited capacity to provide bilingual and bicultural assistance. The development of a bilingual and bicultural workforce is a necessary yet long-term solution. More immediate strategies, however, are needed to meet the needs of immigrant Latinos. This paper describes the development of a stress-reduction focused, lay health advisor training that targets individual behavior change among Latina immigrants. The theoretical foundation, curriculum components, and pilot implementation of the training are discussed. As natural leaders, Latina promotoras disseminated learned strategies and resources within their communities. The lay health advisor model is a salient method for disseminating information regarding mental health and stress reduction among Latinas.
... Recruitment. In the early 1990s, Eng and Hatch (1991) developed a model for using lay health advisors recruited from the church to link at-risk people to community resources. The DFL staff (CDE and project manager) provided 24 volunteer parishioners known as Church Health Representatives (CHRs) with formal training in the Stanford Chronic Disease Self-Management program (Lorig, Gonzalez, & Laurent, 2006). ...
Diabetes for Life (DFL), a project of Memphis Healthy Churches (MHC) and Common Table Health Alliance (CTHA; formerly Healthy Memphis Common Table [HMCT]), is a self-management program aimed at reducing health disparities among African Americans with type 2 Diabetes Mellitus in Memphis and Shelby County, Tennessee. This program is one of five national projects that constitute The Alliance to Reduce Disparities in Diabetes, a 5-year grant-funded initiative of The Merck Foundation. Our purpose is to describe the faith-based strategies supporting DFL made possible by linking with an established informal health system, MHC, created by Baptist Memorial Health Care. The MHC network engaged volunteer Church Health Representatives as educators and recruiters for DFL. The components of the DFL project and the effect on chronic disease management for the participants will be described. The stages of DFL recruitment and implementation from an open-access to a closed model involving six primary care practices created a formal health system. The involvement of CTHA, a regional health collaborative, created the opportunity for DFL to expand the pool of health care providers and then recognize the core of providers most engaged with DFL patients. This collaboration between MHC and HMCT led to the organization of the formal health network.
... The study was guided by three conceptual models: the Lay Health Advisor model, Flaskerud and Winslow's vulnerable populations' framework, and the Behavioral Model for Vulnerable populations [18][19][20]. This integrated model informed our understanding of the multiple, interrelated characteristics that influence African American women's willingness to participate in cancer clinical trials, including: (1) patient and caregiver-related characteristics (age, race, education, health preferences, uncertainty about research, transportation, childcare, time, and additional costs) [21][22][23]; and (2) physicianrelated characteristics (scheduling appointments, protocol compliance issues, and access to and/or awareness of trials) [24][25][26][27]. ...
Cancer clinical trials are important for resolving cancer health disparities for several reasons; however, clinical trial participation among African Americans is significantly lower than Caucasians. This study engaged focus groups of 82 female African American cancer survivors or cancer caregivers, including those in better resourced, more urban areas and less resourced, more rural areas. Informed by an integrated conceptual model, the focus groups examined perceptions of cancer clinical trials and identified leverage points that future interventions may use to improve enrollment rates. Study findings highlight variation in community knowledge regarding cancer clinical trials, and the importance of community education regarding clinical trials and overcoming historical stigma associated with clinical research specifically and the health care system more generally. Study participants commented on the centrality of churches in their communities, and thus the promise of the church as loci of such education. Findings also suggested the value of informed community leaders as community information sources, including community members who have a previous diagnosis of cancer and clinical trial experience. The sample size and location of the focus groups may limit the generalizability of the results. Since the women in the focus groups were either cancer survivors or caregivers, they may have different experiences than nonparticipants who lack the close connection with cancer. Trust in the health system and in one's physician was seen as important factors associated with patient willingness to enroll in clinical trials, and participants suggested that physicians who were compassionate and who engaged and educated their patients would build important trust requisite for patient participation in clinical trials.
... Moreover, these helping activities are not replicated within the context of traditional healthcare service and should be nurtured and extended so that they may complement existing services (Eng, Parker and Harlan 1997;Patterson 1977). Healthcare and other service agencies, therefore, can benefit by accessing existing natural helper networks in their outreach efforts (Eng and Hatch 1991;Eng, Parker and Harlan 1997). ...
This study examines promotoras from the U.S.-Mexico border. Promotoras are women who live in colonias throughout the border area and who are employed by service provider and community development organizations to do health-related outreach and education with colonia residents. The role of promotoras can be seen from the perspective of culture brokerage; that is, they are mediators between local communities and external actors such as service providers and agencies of the government. As culture brokers, promotoras facilitate the relationship among the local communities, and the system of services and outside resources. The study proposes a conceptual framework through which programs of community health workers in general, and those involving promotoras in particular, can be understood, designed, and implemented.
... Thus, there is a dearth of literature on successful behavioral lifestyle programs with primary focus on HTN control in AA church settings. Last, many of these programs did not have an expert and church health counselor team working together as program interventionists (that we bring in this project), and this is one reason for the nonsustainability of the programs and for the limited commitment by church members [72,73]. Also, none of these behavioral lifestyle programs were tailored towards reducing future risk of HTN in AA communities. ...
Hypertension (HTN) is a highly prevalent risk factor for cardiovascular (CV), cerebrovascular, and renal diseases and disproportionately affects African Americans (AAs). It has been shown that promoting the adoption of healthy lifestyles, ones that involve best practices of diet and exercise and abundant expert support, can, in a healthcare setting, reduce the incidence of hypertension in those who are at high risk. In this paper, we will examine whether similar programs are effective in the AA church-community-based participatory research settings, outside of the healthcare arena. If successful, these church-based approaches may be applied successfully to reduce the incidence and consequences of hypertension in large communities with potentially huge impact on public health.
... One such alternate avenue for Black Americans is the church. A number of au- thors have pointed to the importance of the church in the his- tory of Black America; it has served as a source of commu- nity empowerment (Lincoln & Mamiya, 1990;Moore, 1991) and of help to those in the congregation and community (Caldwell, Greene, & Billingsley, 1994;Chang, Williams, Griffith, & Young, 1994;Eng & Hatch 1992;Taylor & Chatters, 1986, 1988Williams, Griffith, Young, Collins, & Dodson, in press), and as a facilitator of social and health inter- ventions for parishioners (Levin, 1984(Levin, , 1986Williams et al., in press). In a study that compared Black and White church congregations, Chaves and Higgins (1992) showed that Black congregations are more active on civil rights issues and in helping community members who face economic hardship. ...
Research has been oriented toward elucidating the links between religion and mental health. The purpose of this article is to further our knowledge in this area by examining the effect of religious activity on depressive symptomatology among community-dwelling elderly persons with cancer. We also test whether these effects differ between Blacks and Whites.
We use two waves of data collected from a community-dwelling sample of elderly persons living in North Carolina. Depressive symptomatology is measured using four subscales from the CES-D 20 scale: somatic-retarded activity, depressed affect, positive affect, and interpersonal relations. Measures of religious activity include service attendance, religious devotion, and watching or listening to religious programs.
The findings indicate that among Blacks with cancer, religious activity is related to lower levels of depressive symptomatology; no such relationship is found for respondent with other illnesses or no illness. Further, the effects of religious activity are stronger among Blacks than Whites.
The analyses lend support to the hypothesis that religious activity is a strong predictor of depression in elderly adults with cancer. This finding, however, is not as strong as we had anticipated.
Religion is a pervasive and influential phenomenon in the livesof many people. Instances of religious behavior are easily foundin almost all societies and cultures of the world. However, psychologyas a behavioral science has largely ignored the studyof religion and its profound impact on human behavior. Thisarticle attempts to explore the relationship between psychologyand religion and how these two disciplines interact. After a generaloverview of the relationship between the two disciplines,Islamization of psychology is suggested as a way out of the currentimpasse between psychology and religion. *This article was first published in the American Journal of Islamic Social Sciences 15, no. 4 (1998):97-116
Purpose:
There is minimal information regarding the Reach and Adoption of evidence-based weight loss maintenance interventions for African Americans of faith.
Design:
The WORD (Wholeness, Oneness, Righteousness, Deliverance) was an 18-month, cluster randomized trial designed to reduce and maintain weight loss in African American adults of faith. Participants received the Diabetes Prevention Program adapted core weight loss program for 6 months, and churches were subsequently randomized to 12-month maintenance treatment or control. All participants underwent body weight and associated behavioral and psychosocial assessments at baseline, 6, 12, and 18 months. The current article focuses on assessing Reach and Adoption at baseline and 6 months using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework.
Setting:
Lower Mississippi Delta.
Participants:
Thirty churches, 61 WORD Leaders (WLs), and 426 participants.
Intervention:
Group delivered by trained community members (WLs).
Measures:
Body mass index and percentage weight lost from baseline to 6-month follow-up were measured. Reach was assessed at participant, WL, and church levels through calculating participation rates and sociodemographics of each level. Adoption was assessed at church and WL levels.
Analysis:
Descriptive statistics summarized baseline characteristics of each level. Continuous and categorical end point comparisons were made.
Results:
Participants' participation rate was 0.84 (n = 437 agreed to participate, n = 519 eligible invited to participate); they were predominantly female, employed, and had a mean age of 49.8. Dropouts by 6 months were younger, had differential marital status, and religious attendance compared with retained participants. Church participation rate was 0.63 (n = 30 enrolled, n = 48 eligible approached) and the majority reported ≤100 active members. The WL participation rate was 0.61 (n = 61 implemented intervention, n = 100 eligible approached); they were primarily female and aged 53.9 (mean).
Conclusion:
Recruitment, engagement, and delivery strategies employed by the WORD show promise of sustained engagement and adoption in other faith-based behavioral weight management programs for African Americans.
Black churches are pivotal institutions in the lives of African Americans (Mattis and Jagers 2001; Taylor, Lincoln, and Chatters 2005). They have been embedded in the social, economic, political, health, and educational fabric of Black communities since the establishment of the first Black church in the eighteenth century (Billingsley 1999). Researchers and service practitioners now recognize the potential of Black churches for addressing the physical, social, and psychological well-being of African Americans through both their spiritual and community outreach missions. Previous research confirms the vital role Black churches can play in working with community-based researchers and service agencies in efforts to reach diverse African American populations (Caldwell, Greene, and Billingsley 1994; Eng and Hatch 1991; Hatch and Derthick 1992; Resnicow 2000; Williams et al. 1999).
A sociological study of religious authority and gender in the context of a rural, impoverished community was conducted in African American churches in one county of the Arkansas Lower Mississippi Delta region to understand relationships between religious leadership, gender, race, and social justice. Three female and three male African American pastors were interviewed as key-informants of their churches to investigate views of female religious authority, and to compare and contrast the congregational culture of female-headed vs. male-headed churches. Among male-headed congregations, views of gender and leadership were complex, with beliefs ranging from no support to full support for female-headed congregations. Two congregational cultures emerged from the data: Congregations with a Social Activist orientation focused on meeting the social needs of the community through Christ, whereas congregations with a Teach the Word orientation stressed the importance of meeting the spiritual needs of the community through knowing the Word of God. Although aspects of both congregational cultures were present to some extentin all six congregations studied, the Social Activist culture played a more dominant narrative in female-headed congregations, whereas the Teach the Word culture was more evident in male-headed congregations. This study reports preliminary information about gender and religious authority in rural African American churches by revealing the different clergy training requirements and church placements of female and male clergy, a myriad of views about female religious authority in the African American faith community, and through uncovering two distinct congregational cultures. This study also enhances understanding on the role of gender in Black churches' perceptions and interactions with rural, socioeconomically challenged communities.
The Institute of Medicine advocates the examination of innovative models of care to expand mental health services available for older adults. This article describes training and supervision procedures in a recent clinical trial of cognitive behavioral therapy (CBT) for older adults with generalized anxiety disorder (GAD) delivered by bachelor-level lay providers (BLPs) and to Ph.D.-level expert providers (PLPs). Supervision and training differences, ratings by treatment integrity raters (TIRs), treatment characteristics, and patient perceptions between BLPs and PLPs are examined. The training and supervision procedures for BLPs led to comparable integrity ratings, patient perceptions, and treatment characteristics compared with PLPs. These results support this training protocol as a model for future implementation and effectiveness trials of CBT for late-life GAD, with treatment delivered by lay providers supervised by a licensed provider in other practice settings.
Faith-based organizations (FBO) continue to play a significant role in the lives of individuals and communities in the United States. This study focused on the contributions of FBO to the health and well-being of residents of Rio Grande Valley, South Texas. Specifically, this study examined two main areas of involvement of FBO in Hidalgo County, Texas: health initiatives and community social services. Despite their influential and historical involvement, FBO partnership in the delivery of health and social services is not well accounted for. This study explores the characteristics of the clergy, parishioners, and FBO that are associated with community health initiatives and social services. Analyses revealed that FBO deliver a remarkably wide range of services. On a weekly basis, one in six or 17 % of Hidalgo County residents were reported as receiving some form of health assistance or social services from county FBO. Variations exist depending on the characteristics of the clergy and the FBO. Policy and practice recommendations include engaging in additional networking, organizing resources, and strengthening FBO health initiatives.
African-American clergy's ability to recognize late-life depression and their capacity to provide support with this illness have been neglected in the literature. Using a mental health literacy framework, the purpose of this research was to explore African-American clergy's knowledge of and treatments for late-life depression. In-depth interviews were conducted with nine African-American clergy who oversaw churches in central Kentucky. Collectively, all clergy were literate and aware of the need to provide support to elders with late-life depression. This study seeks to further clarify the role of African-American clergy and their understanding of late-life depression to inform future interventions and better collaborative relationships.
PURPOSE: Widespread prevention of cardiovascular disease (CVD) requires significant aggregate lifestyle behavior changes. Extensive resources including money, time, access, facilities, materials, and programs are needed to bring about such behavior changes on a large scale. Over the past several decades, funds for large scale public health efforts and related CVD research have become more difficult to acquire, and prevention efforts have been shifting to state and community sites. Thus, large scale behavior modification for CVD prevention requires active efforts to access resources from partnerships with multiple private sector organizations. METHODS: Religious organizations (ROs) are a potentially valuable channel with many advantages for undertaking behavior change programming in partnership with public health researchers. ROs have a broad direct 'reach' with people and provide social support structures, facilities, volunteers, communication channels and access to many sub-populations as well as a compatible mission and history of interest in health. In spite of the many advantages of partnerships between CVD health researchers and ROs, very few formal research studies have been conducted. Existing reports have emphasized the feasibility and powerful benefits of implementing RO-based health programs; however, little data or formal hypothesis testing have been reported. Very few formal CVD research projects have employed scientifically acceptable research designs with random assignment of intact groups to intervention and comparison conditions. RESULTS: In this review, conducted by the current authors, only six projects have been identified that meet these more rigorous scientific criteria. In a discussion of these projects, we classify RO-based studies into four levels of involvement of the RO: 1) use of ROs as sites for recruitment and tracking of experimental subjects; 2) use of RO facilities to conduct interventions; 3) involvement of RO members in delivering behavior change programs; and 4) the addition of significant religious components as an integral part of the intervention. This paper discusses the design, results and implications of these studies including information on what we already know about conducting research with ROs, gaps in existing research and recommendation for future studies. CONCLUSIONS: There is enormous untapped potential for RO-based CVD prevention research, but considerably more work is required to achieve the level of research that is currently conducted in other channels such as worksites and schools. Health practitioners/researchers and ROs are increasingly seizing the opportunity for partnerships to improve health. The knowledge gained from these projects and their documented successes will hopefully encourage other components of the public health system such as hospitals, managed care organizations and departments of health to continue developing ways of including ROs in health research and behavior change programming.
The purpose of this descriptive study was to determine urban African-American clergy's awareness of Alzheimer's disease and willingness to provide support to elders and their family/caregivers. Interviews were conducted with nine African-American clergy who presided over churches in central Kentucky. Collectively, all clergy had previous experience providing pastoral care to adults with Alzheimer's disease and were literate regarding its treatment. Study findings also revealed clergy were inclined to partner with their internal “health care” ministries and/or members with specialized knowledge of mental health services in an effort to provide education and emotional support to congregants in need. These findings have implications for social workers building collaborative community treatment relationships.
Introduction
Evidence-based health promotion programs that are disseminated in community settings can improve population health. However, little is known about how effective such programs are when they are implemented in communities. We examined community implementation of an evidence-based program, Body and Soul, to promote consumption of fruits and vegetables.
Methods
We randomly assigned 19 churches to 1 of 2 arms, a colon cancer screening intervention or Body and Soul. We conducted our study from 2008 through 2010. We used the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to evaluate the program and collected data via participant surveys, on-site observations, and interviews with church coordinators and pastors.
Results
Members of 8 churches in Michigan and North Carolina participated in the Body and Soul program. Mean fruit and vegetable consumption increased from baseline (3.9 servings/d) to follow-up (+0.35, P = .04). The program reached 41.4% of the eligible congregation. Six of the 8 churches partially or fully completed at least 3 of the 4 program components. Six churches expressed intention to maintain the program. Church coordinators reported limited time and help to plan and implement activities, competing church events, and lack of motivation among congregation members as barriers to implementation.
Conclusions
The RE-AIM framework provided an effective approach to evaluating the dissemination of an evidence-based program to promote health. Stronger emphasis should be placed on providing technical assistance as a way to improve other community-based translational efforts.
Religion's association with better physical health has been partially explained by health behaviors, psychosocial variables, and biological factors; but these factors do not fully explain the religion-health connection. In concert with the religion and health literature, a burgeoning literature has linked social capital with salubrious health outcomes. Religious organizations are recognized in the social capital literature as producers and facilitators of social capital. However, few studies have examined the potential mediating role of social capital in the religion-health relationship. Thus data from the 2006 Social Capital Community Benchmark Survey were analyzed for 10,828 adults. The composite unstandardized indirect effect from religion to social capital onto health was significant (beta = 0.098; p < 0.001). The unstandardized direct pathway from religion to self-reported health (beta = 0.015; p = 0.336) indicated that social capital is a mediator in the religion-health relationship. Among the demographic variables investigated, only age and income had a significant direct effect on self-reported health.
The second decade of AIDS demands a response of new and creative efforts for HIV/AIDS prevention education and ministering to persons affected by and living with HIV/AIDS. Jewish and Christian theological and faith‐based arguments are presented to support the call to educate for prevention and the call to minister. The need to network and collaborate with public health for more effective programs is also outlined.
Grounded in a model of service utilization, this study conceptualizes attendance of African-American women at an HIV prevention intervention as associated with influences across three ecological domains—individual, service (program), and social network. First, the texts of responses to semistructured, open-ended elicitation interviews were analyzed. Survey items that conceptually matched the influences on attendance were then selected for subsequent analyses. In order to assess the contributions of groups of variables in separate domains, three blocks of independent variables were entered in a hierarchical regression. The hierarchical regression revealed that individual domain variables (age, level of education, and perception of racism) accounted for 18% of variance in attendance. After controlling for these variables, program domain variables (use of counseling and staff friendliness) accounted for an additional 7% of variance. The social network domain (influence of friends) did not account for any additional variance. It appears that several factors in different ecological domains may influence attendance at HIV prevention interventions. The modifiable factors found here can be used by researchers and practitioners to improve the attendance of racial and ethnic minority populations, those at most risk for HIV exposure, at prevention interventions. © 2006 Wiley Periodicals, Inc.
Data from structured interviews with 2,285 respondents for the Filipino American Community Epidemiological Survey (FACES) were used to examine help-seeking for emotional distress among Filipino Americans. The influence of religious affiliation, religiosity, and spirituality upon help-seeking from religious clergy and mental health professionals was assessed after controlling for need (e.g., negative life events, SCL-90R scores, and somatic symptoms), demographic (e.g., age, gender, marital status, education, county of residence, generational status, and insurance coverage), and cultural variables (e.g., loss of face and language abilities). Rates of help-seeking from religious clergy versus mental health professionals were comparable (2.5% vs. 2.9%). High religiosity was associated with more help-seeking from religious clergy but not less help-seeking from mental health professionals, whereas high spirituality was associated with less mental health help-seeking. Implications for understanding how religious variables affect help-seeking were explored. © 2004 Wiley Periodicals, Inc. J Comm Psychol 32: 675–689, 2004.
PURPOSE: Since the 1970s, health promotion and disease prevention programs that rely on lay health advisors have proliferated, making it important to ascertain the levels and types of activity that can reasonably be expected from such advisors. This report describes the activities of lay health advisors participating in a program to increase mammography screening by older African American women and shares lessons that the authors learned about evaluating advisors' activities.
DESCRIPTION OF STUDY: Between September 1994 and January 1996, 144 lay health advisors, associated with the North Carolina Breast Cancer Screening Program, were asked to complete, on a periodic basis, a standardized, self-administered activity report that asked about group presentations in the past 3 months and one-on-one contacts in the past week. Eighty-five advisors submitted one or more reports. The authors tabulated responses for lay health advisors overall, for those turning in one or more reports, and for those reporting a specific type of activity.
RESULTS: The responses showed that North Carolina Breast Cancer Screening Program lay health advisors made approximately one group presentation every 3 months and had one to three individual contacts per week. Group presentations were commonly in churches and homes, and focused on who needs a mammogram, how then, and where to get one. During one-on-one encounters, advisors primarily encouraged women to get mammograms or discussed fears about mammograms.
CLINICAL IMPLICATIONS: Information about lay health advisor activities serves several important purposes. Such information allows programs to identify the types of messages that lay health advisors transmit and the number of contacts they make, while also identifying the groups that are more and less difficult to reach, and the topics and locations favored by advisors and the women they contact. Activity data may indicate what resources or other support the advisors need, whether in-service training is necessary, and how to enhance the recruitment and training of additional lay health advisors.
s Although the importance of working with people within their natural settings has been advocated since the 1965 conference at Swampscott, community psychologists have had relatively little discourse about religious settings when compared to the vast number of studies undertaken in other settings— schools, family environments, workplaces, and hospitals, to name a few. Only in recent years have some community psychologists begun to explore the potential benefits of working within religious and spiritual settings. We assert that this omission has resulted in little work centered in the context of religious settings, and consequently may limit the scope of our theories and the effectiveness of our interventions. In this article we argue that there is sufficient evidence to conclude that locating research and intervention projects in religious contexts can enrich the study and practice in the field. We consider first the history of the relationship between religion and psychology in research and practice, and review community psychology's discussion of religious settings over the past 25 years. We then discuss the relevance of these settings for community psychology by reviewing empirical findings within a conceptual framework of key constructs of community psychology. We argue that work in many religious settings is consistent with the priorities associated with these constructs. Furthermore, collaboration with religious organizations which share priorities with community psychology can help both community psychologists and participants of these religious settings achieve their goals. © 2000 John Wiley & Sons, Inc.
This paper reviews the literature on the roles of community-wide collaboration in substance abuse prevention. Three broad strategies through which collaboration may have its effects are identified (i.e., building community capacity, increasing service integration, and influencing policy change). Alternative theories of effects, means of measurement, and results and conclusions from studies of collaborative interventions for prevention are discussed. The strength of empirical evidence for the impact of collaboration on substance abuse outcomes varies by strategy, with more support for the logic of policy change. Additional conclusions are offered regarding when and how this approach can work, and what might be useful next steps.
Hungary is a country in transition that has no real tradition of peer helping. A qualitative study was carried out involving
13 peer helpers of two kinds (a) age-based peers, and (b) way-of-life-based peers (fellow helpers). The motivations for and
the processes of becoming a peer helper were analyzed. Results showed the largest difference being that the motivation for
becoming an aged-based peer helper tended to involve aspirations for a professional helping career, whereas way-of-life-based
peer helpers typically involved recovery narratives. The experiences suggest that a helping system involving civil society
(peers) might develop from a state-controlled help system.
Churches have been a popular site for the implementation of health promotion interventions. Although the efficacy of church-based health programs have been established, it is unknown which aspects of church-based health promotion drive health behavior change. Process evaluation is a way to increase our understanding of key components of church-based health promotion and to move the field forward. Thus, a systematic review of the utilization of process evaluation in church-based health programs was conducted. Articles from 1990 to 2008 were screened for eligibility, resulting in the analysis of 67 articles. The majority of church-based health programs assessed recruitment (88.1%) and reach (80.6%). About 28.4% assessed dose delivered, and 27.3% measured dose received. Context and fidelity was assessed by 34.3% and 20.9%, respectively, of church-based interventions. Approximately 9% of church-based programs measured fidelity. On average, only three of seven possible components of process evaluation were measured among the studies reviewed. The number of process evaluation components assessed did not differ by program feature (e.g., target population, target health condition, program objective, etc.). Consistency in the conceptualization and measurement of process evaluation may facilitate the implementation of a comprehensive process evaluation effort in church-based and other health promotion interventions.
This study examined the relationship between religiosity and the affective and immune status of 33 HIV-seropositive mildly symptomatic African-American women (CDC stage B) in a replication of a prior study that reported an association between religiosity and affective and immune status in HIV-seropositive gay men. All women completed an intake interview, a set of psychosocial questionnaires, and provided a venous blood sample. Consistent with prior work, factor analysis of 12 religious-oriented response items revealed two distinct aspects to religiosity: religious coping and religious behavior. Religious coping (e.g. placing trust in God, seeking comfort in religion) was significantly associated with lower depression and anxiety. Regression analyses revealed the association between religious coping and depressive symptoms appears to be mediated by an active coping style. However, the association between religious coping and anxiety does not appear to be mediated by either active coping or sense of self-efficacy in these women. In contrast to prior work, neither religious coping nor religious behavior was significantly associated with immune status as measured by T helper-inducer (CD41) cell counts.
To test the efficacy of using hair stylists as lay health advisors to increase organ donation among African American clients.
This study was a randomized, controlled intervention trial where we randomized 52 salons (2,789 clients) to receive a 4 session, stylist-delivered health education program (comparison) or a four session brief motivational intervention that encouraged organ donation (intervention). Intervention stylists received a four-hour training in organ donation education and counseling. Organ donation was measured by self-report questionnaire at 4-month posttest as well as by verified enrollment in the Michigan Organ Donor Registry.
Hair salons in Michigan urban areas.
Blacks (n = 2,449), non-Blacks (n = 261) in Michigan.
Self-reported donation status, registration in Michigan Organ Donor Registry.
At posttest, rates of self-reported positive donation status were 19.8% in the intervention group and 16.0% in the comparison group. In multivariate analyses, intervention participants were 1.7 times (95% Cl = 0.98-2.8) more likely than comparison participants to report positive donation status at posttest. Based on verified organ registry data, enrollment rates were 4.8% and 2%, respectively for the intervention and comparison groups. In multivariate analyses, intervention group members were 4.4 (95% CI = 1.3-15.3) more likely to submit an enrollment card than comparison participants.
Clients of hair stylists trained to provide brief motivational intervention for organ donation were approximately twice as likely to enroll in the donor registry as comparison clients. Use of lay health advisors appears to be a promising approach to increase donation among African Americans.
INTRODUCTION: The community health worker (CHW) model is a popular method for reaching vulnerable populations with diabetes. This study assessed implementation and effectiveness of the model within diabetes programs.
METHODS: Four databases were searched to identify diabetes programs implementing the CHW model. Corresponding articles were reviewed and semi-structured interviews were conducted with directors of each program.
RESULTS: Eight studies met inclusion criteria for review and their program managers were interviewed. Five CHW roles were identified: educator, case manager, role model, program facilitator, and advocate. Roles, responsibilities and training varied greatly across programs. Selected outcomes also varied, ranging from physiologic measures, to health behaviors, to measures of health care utilization and cost.
CONCLUSIONS: Research regarding application of the community health worker model in diabetes management is limited and consensus regarding the scope of the CHW's role is lacking. Future studies should rigorously examine how best to integrate this promising model into chronic disease management.
Collaborative and participatory research approaches have received considerable attention as means to understanding and addressing disparities in health and health care. In this article, the authors describe the process of building a three-way partnership among two academic health centers-Duke University and the University of North Carolina-and members of the Latino community in North Carolina to develop and pilot test a lay health advisor program to improve Latina immigrants' mental health and coping skills. The authors applied the principles of participatory research to engage community and academic partners, to select the health topic and population, and to develop program goals and objectives. Key challenges were negotiating administrative structures and learning institutional cultures, as well as dealing with contextual issues such as mental health reform and antiimmigrant sentiment in the state.Some important lessons learned are to seek opportunities for taking advantage of existing relationships and expertise at each academic institution, to be respectful of the burden of research on vulnerable communities, and to involve community partners at all stages of the process.
In the wake of welfare reform, many states-including Mississippi-have considered utilizing religious congregations as a provider of services to the needy. The possibility of utilizing religious congregations to provide social services previously borne by the state stems from the "charitable choice" portion of the 1996 welfare reform law. This study examines the feasibility of implementing charitable choice initiatives through Mississippi religious congregations with state block grant monies. Our investigation is guided by the following questions: (1) What types of relief do faith communities currently provide, and how is such aid provided? Specifically, how do congregational standards and social hierarchies (e.g., race, social class, perceptions of the poor, congregational authority structures) currently affect aid provision? (2) How are public assistance programs and, more recently, welfare reform initiatives viewed by local religious leaders? (3) Finally, to what degree are local religious leaders willing to entertain participating in charitable choice initiatives (i.e., church-state aid-provision partnerships) in the wake of welfare reform? To address this set of interrelated questions, our full study brings an array of both quantitative and qualitative data sources to bear on this important issue: in-depth interview, ethnographic data, and primary survey data drawn from local congregations in our sample, complemented by analyses of select contextual-level Census and administrative data. This report focuses most pointedly on findings distilled from over six-hundred pages of in-depth interview transcripts culled from local religious leaders representing a diverse sample of twenty-nine congregations in Mississippi's Golden Triangle Region. Several key findings emerge from our study. First, pastors typically understand religiously-based aid as a holistic form of relief that, ideally, addresses both material and non-material needs. We describe this multi-di
While the ultimate goal of health education interventions is to positively influence health status, more proximal indicators of success are changes in intermediate outcomes, or impact. Because health education interventions work through intermediate outcomes, the linkage to health status is often assumed to be at a conceptual or theoretical level. The term health education intervention strategy is a heuristic device used to conceptualize and organize a large variety of activities. There is a wide range of studies and reports in the literature that either test specific intervention strategies or report on larger health education efforts combining several strategies. This article organizes the discussion to focus on individual-, community-, and policy-level interventions. Mass communications are also considered, and the authors comment on program planning issues that cut across specific interventions at the individual, community, and policy levels. Eleven recommendations are offered for future health education intervention research.
The dominant theoretical models used in health education today are based in social psychology. While these theories have increasingly acknowledged the role of larger social and cultural influences in health behavior, they have many limitations. Theories seek to explain the causes of health problems, whereas principles of practice, which are derived from practical experience, assist intervenors to achieve their objectives. By elucidating the relationships between theory and practice principles, it may be possible to develop more coherent and effective interventions. The key research agenda for health education is to link theories at different levels of analysis and to create theory-driven models that can be used to plan more effective interventions in the complex environments in which health educators work.
The Save Our Sisters Project builds on the roles of 95 "natural helpers" to increase mammography screening among older African American women in a NC county. Natural helpers are lay people to whom others naturally turn for advice, emotional support, and tangible aid. Findings from 14 focus group interviews showed that older women seek out these individuals when they have a female-specific concern, rather than or before seeking help from professionals. The characteristics of natural helpers, revealed in the findings, were used to identify and recruit them to become trained lay health advisors in breast cancer education. Through the SOS Project, natural helpers provide a community-based system of care and social support that complements the more specialized role of health professionals; linking them to women through places and ways that no health professional could begin to acquire. The three roles of lay health advisors are: (1) to assist individuals in their social networks with needs that are difficult for professionals to address; (2) to negotiate with professionals for support for the health system; and (3) to mobilize the resources of associations in their community to sustain support from the health system.
If political dynamics are included in the definition of community, health promotion programs have a greater potential to recognize that assisting people to empower their communities is as important as assisting them to improve their health. This paper reports on the evaluation methods employed for a health promotion program in a rural poor county of the Mississippi Delta that chose to define community in this way. The evaluation took an action research approach so that the methods would not contradict or interfere with the program's empowerment agenda. The methods required a close and collaborative working relationship among evaluators and local service providers, community leaders, and program staff who defined and operationalized eight dimensions of community competence, determined the units of analysis, and developed the data collection protocol. Emphasis was placed on using the data to engage the program and three communities in a dialogue on how to confront a system with the difficult issues they faced. The findings revealed that after 1 year of implementation, community competence moved from social interactions internal to communities to those more externally focused on mediating with outside institutions and officials. At the same time, measures of self-other awareness and conflict containment showed a decrease or virtual nonexistence.
The North Carolina Native American Cervical Cancer Prevention Project was a 5-year (1989-1995) National Cancer Institute-funded, community-based, early detection of cervical cancer intervention implemented among two Native American tribes in North Carolina: the eastern band of the Cherokee Indians and the Lumbee. The initial quantitative analysis of the intervention showed modest effects and found that the intervention had different effects in the two communities. Due to the equivocal findings, a retrospective qualitative study was conducted. The qualitative study found that two types of factors influenced the intervention's results. The first were project and intervention characteristics, and the second were community and cultural factors over which the project had no control. The community and cultural factors took two forms: enhancers, which contributed to greater intervention effect, and attenuators, which created barriers to success. Examples of each factor are presented, and implications for cervical cancer detection among Native American women are discussed.
During the past 20 years there has been a dramatic increase in societal interest in preventing disability and death in the United States by changing individual behaviors linked to the risk of contracting chronic diseases. This renewed interest in health pro motion and disease prevention has not been without its critics. Some critics have accused proponents of life-style interventions of promoting a victim-blaming ideology by neglecting the importance of social influences on health and disease.
This article proposes an ecological model for health promotion which focuses atten tion on both individual and social environmental factors as targets for health promo tion interventions. It addresses the importance of interventions directed at changing interpersonal, organizational, community, and public policy, factors which support and maintain unhealthy behaviors. The model assumes that appropriate changes in the social environment will produce changes in individuals, and that the support of individ uals in the population is essential for implementing environmental changes.
Examines relapse by integrating knowledge from the addictive disorders of alcoholism, smoking, and obesity. Commonalities across these areas suggest at least 3 basic stages of behavior change: motivation and commitment, initial change, and maintenance. A distinction is made between lapse and relapse, with lapse referring to the process (slips or mistakes) that may or may not lead to an outcome (relapse). The natural history of relapse is discussed, as are the consequences of relapse for patients and the professionals who treat them. Information on determinants and predictors of relapse is evaluated, with the emphasis on the interaction of individual, environmental, and physiological factors. Methods of preventing relapse are proposed and are targeted to the 3 stages of change. (156 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The contribution of spiritual support (perceived support from God) to well-being, especially under conditions of high versus low life stress, has received little empirical study. In the present research, the relationship of spiritual support to well-being for several high and low life-stress samples was examined. With demographic variables controlled, regression analyses indicated that spiritual support: 1) was inversely related to depression and positively related to self-esteem for high life-stress (recently bereaved) parents; and 2) in a prospective (longitudinal) analysis with pre-college depression controlled, spiritual support was positively related to personal-emotional adjustment to college for high life-stress (three or more life events), first-semester college freshmen. Spiritual support was not significantly related to well-being for low life-stress subsamples. The implications of the findings for future research and intervention are discussed.
Health-related situations pose a particular challenge to the need to find justice, meaning and control in life. This study points to the rich and varied ways that attributions to God are integrated into attempts to maintain meaningful views of the world and to cope with the world. A sample of 124 undergraduates was presented with four health-related situations depicting responsible or irresponsible behavior followed by a positive or negative outcome. They then responded to causal and coping attribution items. As predicted, attributions to God's will, God's love and God's anger were greater in noncontingent/unjust, positive outcome, and negative outcome situations respectively. Attributions to God's will appeared to represent a benign, external, alternative explanation to chance attributions. The results also support the view that people turn to God for help in coping more commonly as a source of support during stress than as a moral guide or as an antidote to an unjust world. Generally, these findings underscore the need for further integration of religious concepts into the general attribution and coping literatures.
Preventive strategies within the framework of an ecological paradigm combine elements of theory, ideology, and practice method, among others. The theory posits a relationship between socially integrated community systems and wellness, both physical and mental. The ecological focus on adaptation constrains an ideological emphasis on health and on the natural caring function of the "informal economy." Practice strategies focus on the design of supportive environments that enhance competence and that maximize the utilization of natural social processes for the achievement of preventive ends.
Religion represents an important resource for efforts to prevent significant personal and social problems. Yet, far from a unitary phenomena, religions embody fundamentally different world views, interpersonal communities, and practices. This chapter describes the diverse pathways through which religions attempt to influence both the individual congregation member and the larger community and society. The varied implications of these pathways for the well-being of the individual and the social system are considered. Drawing from case studies, several distinctive roles of religion are distilled, roles which raise general questions and challenges for preventive and promotive workers in diverse disciplines. Finally, directions for more effective collaboration between religion and allied disciplines are discussed.
We propose a network analytic approach to the community question in order to separate the study of communities from the study of neighborhoods. Three arguments about the community question-that "community" has been "lost," "saved," or "liberated"-are reviewed for their development, network depictions, imagery, policy implications, and current status. The lost argument contends that communal ties have become attenuated in industrial bureaucratic societies; the saved argument contends that neighborhood communities remain as important sources of sociability, support and mediation with formal institutions; the liberated argument maintains that while communal ties still flourish, they have dispersed beyond the neighborhood and are no longer clustered in solidary communities. Our review finds that both the saved and liberated arguments proposed viable network patterns under appropriate conditions, for social systems as well as individuals.
Presents a collection of 10 lectures on concepts and issues involved in preventive psychiatry, emphasizing the importance of structuring cognitive and emotional supports for people in crisis situations. Topics include an overview and definition of support systems, detection of mental disorders in children, the role of the nurse in mental hygiene, the contribution of the school to personality development, and conceptual models in community mental health. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study explored the potential of a new approach to predicting and understanding the phenomenon of resident participation in community development efforts. A set of variables based on Mischel's "cognitive social learning variables" was compared with a set of traditional demographic and personality variables for ability to predict membership in a block association. The cognitive social learning approach offers an alternative conceptualization to personality theory by using a Person x Situation approach to the explanation of behavior. Factor analysis was used to confirm the operationalization of five cognitive social learning variables. Discriminant function analysis results showed that the cognitive social learning variables contributed significant unique variance to the prediction of membership. Implications for understanding participation decisions and developing community intervention strategies are discussed.
Health educators have created a new professional role that emphasizes the changing of individuals rather than their social conditions. The article shows how historical roots, ideological perspectives, and structural constraints have combined to create an ambiguous, generally conservative role for the health education profession.
Epidemiological evidence is presented that contradicts many implicit notions of disease etiology that underlie health education approaches. Finally, the authors suggest an “ecological” model of health education that takes account of the multiple causes of disease and is committed to progressive social change.
Kerala is a small, densely crowded state in South India. It is a poor state, even by Indian standards. Its per capita income of US120, and it suffers from the lowest per capita caloric intake in India. Nevertheless, Kerala has managed to achieve the demographic transition from high (premodern) to low (modern) birth and death rates—something no other Indian state has been able to attain. Indeed, the magnitude of Kerala's fertility decline—the birth rate fell from 39 in 1961 to 26.5 in 1974—has never before been observed in a nation with comparable levels of income and undernutrition. Other indices of Kerala's social development are equally surprising: levels of literacy, life expectancy, female education, and age at marriage are the highest in India, while mortality rates, including infant and child mortality, are the lowest among Indian states.
But Kerala's anomalous and unexpected demographic trends and levels are not the result of the direct interventions designed to influence health and fertility levels elsewhere in India-conventional strategies of population control and health services delivery that thus far are notable for their failure to generate such positive results. Instead, Kerala's demographic levels evidently reflect a broad social response to structural reforms in its political economy.
In the context of a longitudinal investigation of the physical and mental health consequences of involuntary job loss, it is hypothesized that social supports modify the relationship between unemployment stress and health responses. As a result of two plant shutdowns, 100 stably employed, married men were interviewed at five stages over a two-year period. Social support was measured by a 13-item index covering the extent of supportive and affiliative relations with wife, friends and relatives. The rural unemployed evidenced a significantly higher level of social support than did the urban unemployed, a difference probably due to the strength of ethnic ties in the small community and a more concerned social milieu. No differences between the supported and unsupported were found with respect to weeks unemployed or to actual economic deprivation. However, while unemployed, the unsupported evidenced significantly higher elevations and more changes in measures of cholesterol, illness symptoms and affective response than did the supported. While health differences between supported and unsupported populations under stress are commonly interpreted as evidence that support buffers the effects of life stress, it is argued that these and other study findings demonstrate the exacerbation of life stress by a low sense of social support.
Social support is defined as information leading the subject to believe that he is cared for and loved, esteemed, and a member of a network of mutual obligations. The evidence that supportive interactions among people are protective against the health consequences of life stress is reviewed. It appears that social support can protect people in crisis from a wide variety of pathological states: from low birth weight to death, from arthritis through tuberculosis to depression, alcoholism, and the social breakdown syndrome. Furthermore, social support may reduce the amount of medication required, accelerate recovery, and facilitate compliance with prescribed medical regimens.
It has been hypothesized that in addition to the direct health and amenity benefits of an improved water supply, there are other, more subtle, benefits to communities who participate in community-based water supply projects. A detailed empirical comparison of villages with and without community-based water projects in Indonesia and Togo suggests that such indirect benefits are substantial. Between 25 and 30% more children are immunized in villages with community-based water projects than in comparison villages which either have benefitted from non-participatory water projects, or have had no water project. From a comparison between the activities of villagers and workers in external agencies involved in water projects in the two countries, it is concluded that successful participatory water projects are best characterized as a partnership between the community and the external agency. Such projects require substantial inputs of time, resources, skill and persistence from both the community and the external agency. These inputs must be sustained by both parties in all phases--planning, construction and maintenance--if this partnership is to result in lasting improvements in water supply and other aspects of community life.
The research integrates the citizen participation literature with research on perceived control in an effort to further our understanding of psychological empowerment. Eleven indices of empowerment representing personality, cognitive, and motivational measures were identified to represent the construct. Three studies examined the relationship between empowerment and participation. The first study examined differences among groups identified by a laboratory manipulation as willing to participate in personally relevant or community relevant situations. Study II examined differences for groups defined by actual involvement in community activities and organizations. Study III replicated Study II with a different population. In each study, individuals reporting a greater amount of participation scored higher on indices of empowerment. Psychological empowerment could be described as the connection between a sense of personal competence, a desire for, and a willingness to take action in the public domain. Discriminant function analyses resulted in one significant dimension, identified as pyschological empowerment, that was positively correlated with leadership and negatively correlated with alienation.
The findings reported are based on an exploratory, comparison group study of participants in spiritual healing practices carried out over a 2-year period (1981-1983) in Baltimore, Md. In this study, participation in such forms of healing, which generally occurs in small groups, is related to various measures of psychosocial wellness defined as the emic construct of 'subjective health'. Interview data from regular participants in two types of healing group, charismatic (n = 83) and metaphysical (n = 93), were compared with regular utilizers of primary care (n = 137), using the same data collection procedures. Members of the two types of healing group differ on some social attribute data. Members of charismatic healing groups tend to be of slightly lower SES overall than members of metaphysical healing groups. Members of both types of healing groups, however, had significantly more positive scores on wellness measures than primary care patients, even when sex, age, marital status, illness severity and religiosity were controlled statistically. Findings suggest that such groups play a social support function among regular participants, and that participation in specific healing systems can be seen as a contextual variable which has an effect on subjective self-reports of health or, as defined here, wellness.
The concept of self-efficacy is receiving increasing recognition as a predictor of health behavior change and maintenance. The purpose of this article is to facilitate a clearer understanding of both the concept and its relevance for health education research and practice. Self-efficacy is first defined and distinguished from other related concepts. Next, studies of the self-efficacy concept as it relates to health practices are examined. This review focuses on cigarette smoking, weight control, contraception, alcohol abuse and exercise behaviors. The studies reviewed suggest strong relationships between self-efficacy and health behavior change and maintenance. Experimental manipulations of self-efficacy suggest that efficacy can be enhanced and that this enhancement is related to subsequent health behavior change. The findings from these studies also suggest methods for modifying health practices. These methods diverge from many of the current, traditional methods for changing health practices. Recommendations for incorporating the enhancement of self-efficacy into health behavior change programs are made in light of the reviewed findings.
The positive influence of social support on such health related outcomes as patient adherence to medical regimens and stress reduction at the worksite has captured the attention of public health researchers and practitioners alike. Yet, the broader social outcome of building community competency to undertake and sustain health related solutions without constant intervention from professionals still remains elusive. The difficulty may lie with the need to uncover on each occasion the various roles and functions of social support structures that may or may not exist in a given community. The intent would then be to graft an intervention onto these existing roles and functions in order to mirror the naturally occurring social support structures. A conceptual framework that has been used to institutionalize health related activities through the role and function of the black Church, as a social unit of identity and solution for rural black communities in North Carolina, is put forth for consideration.
The convincing evidence of the relationship between social support, social networks, and health status has influenced the development of program strategies which are relevant to health education. This article focuses on the linkage between social support and social networks and health education programs which involve interventions at the network and community level. Two broad strategies are addressed: programs enhancing entire networks through natural helpers; and programs strengthening overlapping networks/communities through key opinion and informal leaders who are engaged in the process of community wide problem-solving. Following a brief overview of definitions, this article highlights several network characteristics which are often found to be related to physical and mental health status. Suggestions are made for how these network characteristics can be applied to the two program strategies. Principles of practice for the health educator, and some of the limitations of a social network approach are delineated. The article concludes with a recommendation for engaging in action research--a perspective highly consistent with both the strategies discussed and the concepts of social networks and social support. This approach not only recognizes, but also acts to strengthen indigenous skills and resources.
Following a brief overview of the stressful life events-illness model and its implications for intervention, this article highlights the role of social support as a resource for resisting stress-induced illness and disability. It identifies three different connotative meanings that have been assigned to the social support construct, and describes their empirical operationalizations in several recent studies. Specifically, the social integration/participation formulation, the social network approach, and the social intimacy measurement strategy are described and contrasted. Within the latter approach, one study that illuminated types of informal helping behaviors is discussed in greater detail. A review of possible mechanisms whereby social support accomplishes its health-protective impact is also offered, and two types of planned interventions involving the mobilization or optimization of social support are spotlighted. The article concludes with ideas about ways that professionals can safeguard the natural helping skills of citizens and achieve an appropriate balance between formal and informal systems of service delivery in the health and human services fields.
The epidemiological model of host, agent and environmental factors is applied to an analysis of the acceptance or rejection of an accident preventive measure among sugar cane cutters in Puerto Rico. The host factor of "personal readiness" as measured by attitudes towards prevention, concern about having an accident, belief in one's vulnerability, job satisfaction, general adjustment, fatalism, and health knowledge and behavior were found to affect acceptance of the preventive measure. The agent factor as represented by the negative and positive characteristics of the protective measure also strongly affected acceptance. While environmental factors related to exposure to mass media and social participation were found to be related to acceptance, attempts to utilize social pressures to secure acceptance did not prove as successful as direct health education. A model is proposed whereby these three factors of host, agent, and environment could be studied systematically in other community health campaigns.
Since the last comprehensive review in 1974, the Health Belief Model (HBM) has continued to be the focus of considerable theoretical and research attention. This article presents a critical review of 29 HBM-related investigations published during the period of 1974-1984, tabulates the findings from 17 studies conducted prior to 1974, and provides a summary of the total 46 HBM studies (18 prospective, 28 retrospective). Twenty-four studies examined preventive-health behaviors (PHB), 19 explored sick-role behaviors (SRB), and three addressed clinic utilization. A "significance ratio" was constructed which divides the number of positive, statistically-significant findings for an HBM dimension by the total number of studies reporting significance levels for that dimension. Summary results provide substantial empirical support for the HBM, with findings from prospective studies at least as favorable as those obtained from retrospective research. "Perceived barriers" proved to be the most powerful of the HBM dimensions across the various study designs and behaviors. While both were important overall, "perceived susceptibility" was a stronger contributor to understanding PHB than SRB, while the reverse was true for "perceived benefits." "Perceived severity" produced the lowest overall significance ratios; however, while only weakly associated with PHB, this dimension was strongly related to SRB. On the basis of the evidence compiled, it is recommended that consideration of HBM dimensions be a part of health education programming. Suggestions are offered for further research.
Zuckerman, D. M., S. V. Kasl (Yale U. School of Medicine, New Haven, CT 06510) and A. M. Ostfeld. Psychosocial predictors of mortality among the elderly poor: the role of religion, well-being, and social contacts. Am J Epidemiol 1984; 119: 41–23.
Mortality data during a two-year follow-up were obtained on some 400 elderly poor residents of New Haven, Hartford, and West Haven, Connecticut, in 1972–1974. These subjects were cases and controls in a study of the health effects of residential relocation. Initial data collection included a detailed health history, sociodemographic and background variables, and a variety of behavioral and psychological data. The variables selected for analysis in this report were: religious beliefs, social contacts, feelings of well-being, and affective states. Stepwise logistic regressions were used to determine the role of these psychosocial variables in predicting mortality, while controlling for case/control status, demographic variables, and health status (measured by an index maximally predictive of mortality in this sample). Three psychosocial variables were significant predictors: religiousness, happiness (as rated by the interviewers), and presence of living offspring. The first two reduced the risk of mortality primarily among the elderly who were in poor health, while the third one did not interact with health status.
In Reply.—
I find Dr Robert Gillette's letter right on target in virtually all respects. Most important is his concern that preoccupation with high-technology treatment will tend to push out the less esoteric and less dramatic demands required for an effective physician to do his proper job in a community setting. I also thoroughly agree that primary care careers require that physicians be comfortable in dealing with ambiguity and human support systems, rather than simply treating well-differentiated disease per se.I would differ only with his view that today there are too many different kinds of "providers." All of the data suggest that we will never have enough of one kind of provider to do the primary or general-care job as adequately as we might wish. Thus, while I applaud the person- and family-oriented focus of family practitioners, it is my own view that all general physicians in front-line practices
The relationship between professional and natural helpers was the subject of similar studies in Iowa and in Ireland and the United Kingdom. As a result, several clusters of natural helpers were identified and a model for professional-natural helper cooperation was developed.
Analysis of decision making under risk has been dominated by expected utility theory, which generally accounts for people's actions. Presents a critique of expected utility theory as a descriptive model of decision making under risk, and argues that common forms of utility theory are not adequate, and proposes an alternative theory of choice under risk called prospect theory. In expected utility theory, utilities of outcomes are weighted by their probabilities. Considers results of responses to various hypothetical decision situations under risk and shows results that violate the tenets of expected utility theory. People overweight outcomes considered certain, relative to outcomes that are merely probable, a situation called the "certainty effect." This effect contributes to risk aversion in choices involving sure gains, and to risk seeking in choices involving sure losses. In choices where gains are replaced by losses, the pattern is called the "reflection effect." People discard components shared by all prospects under consideration, a tendency called the "isolation effect." Also shows that in choice situations, preferences may be altered by different representations of probabilities. Develops an alternative theory of individual decision making under risk, called prospect theory, developed for simple prospects with monetary outcomes and stated probabilities, in which value is given to gains and losses (i.e., changes in wealth or welfare) rather than to final assets, and probabilities are replaced by decision weights. The theory has two phases. The editing phase organizes and reformulates the options to simplify later evaluation and choice. The edited prospects are evaluated and the highest value prospect chosen. Discusses and models this theory, and offers directions for extending prospect theory are offered. (TNM)
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