NIH Public Access Author Manuscript J Prev Interv Community. Author manuscript; available in PMC 2014 March 09. NIH-PA Author Manuscript Published in final edited form as: J Prev Interv Community. 2012 ; 40(3): 194–207. doi:10.1080/10852352.2012.680411. Pilgrimage to Wellness: An Exploratory Report of Rural African American Clergy Perceptions of Church Health Promotion Capacity Lori Carter-Edwards, PhD1, Elizabeth Gerken Hooten, ScD2, Marino A. Bruce, PhD3, Forrest Toms, PhD4, Cheryl LeMay Lloyd, PhD4, and Calvin Ellison, PhD5 1Department of Community and Family Medicine, Duke University Medical Center, Durham, NC 2Department of Psychiatry and Behavioral Sciences and Center for Spirituality, Theology and Health, Duke University Medical Center, Durham, NC 3University NIH-PA Author Manuscript 4North of Mississippi Medical Center and Jackson State University, Jackson, MS Carolina A & T State University, Greensboro, NC 5Success Dynamics Community Development Corporation, Farmville, NC Abstract NIH-PA Author Manuscript Churches serve a vital role in African American communities and may be effective vehicles for health promotion in rural areas where disease burden is disproportionately greater and healthcare access is more limited than other communities. Endorsement by church leadership is often necessary for the approval of programs and activities within churches; however, little is known about how church leaders perceive their respective churches as health promotion organizations. The purpose of this exploratory pilot was to report perceptions of church capacity to promote health among African American clergy leaders of predominantly African American rural churches. The analysis sample included 27 pastors of churches in Eastern NC who completed a survey on church health promotion capacity and perceived impact on their own health. Capacities assessed included perceived need and impact of health promotion activities, church preparedness to promote health, health promotion actions to take, and the existence and importance of health ministry attributes. The results from this pilot study indicated a perceived need to increase the capacity of their churches to promote health. Conducting health programs, displaying health information, collaborations within the church (i.e., kitchen committee working with the health ministry), partnerships outside of the church, and funding were most commonly reported needed capacities. Findings from this exploratory work lay the foundation for the development of future, larger observational studies that can specify some of the key factors associated with organizational change and ultimately health promotion in these rural church settings. Keywords clergy; African American; health promotion; churches; capacity SEND CORRESPONDENCE TO: Lori Carter-Edwards, PhD, Division of Community Health, Department of Community and Family Medicine, Duke University Medical Center, DUMC Box #104425, Durham, NC 27710; Phone: 919.681.3086; Fax: 919.613.6899; lori.c.edwards@duke.edu. Carter-Edwards et al. Page 2 INTRODUCTION NIH-PA Author Manuscript Despite significant medical discoveries and overall improvement in health in the U.S., disparities in morbidity and mortality among underserved racial minorities persist. In fact, there is a growing concern that the nation's ethnic and racial health gap is widening (U. S. Department of Health and Human Services, 2000). These health disparities are a result of a disproportionate burden of multiple diseases among low-income, racial minority, and rural populations compared to the general population, rather than a different set of unique illnesses among the most vulnerable. Furthermore, they are not limited to one or two conditions, but persist across a very broad spectrum of health conditions and outcomes (Holt et al., 2009). NIH-PA Author Manuscript The racial and ethnic group carrying the excessively highest burden of disease is African Americans. Nearly three decades have passed since publication of the Heckler Report demonstrating that African Americans have the worst overall health profile of all minority groups in the United States (Heckler, 1985). More recent investigations continue to identify African Africans as over-represented among individuals diagnosed with asthma (HatcherRoss, Wertheimer, & Kahn, 2005; Smith et al., 2005; Boudreaux, Emond, Clark, & Camargo, 2003; Zoratti, Havstad, Rodriguez, Robens-Paradise, Lafata, & McCarthy, 1998; Zoratti, 1998); cancer (American Cancer Society, 2007); diabetes (Saaddine et al., 2002; Harris, Eastman, Cowie, Flegal, & Eberhart, 1999); heart disease (Lloyd-Jones & Adams, 2009; Kravitz, 1999), HIV (Cunnigham, Mosen, & Morales, 2000); hypertension (Fields, Burt, Cutler, Hughes, Rokccella & Sorlie, 2004; Hertz, Unger, Cronell,k & Saunders, 2005; Rosamond et al. 2008); kidney disease (Bruce, Beech, Sims, et al., 2009; Hsu, Lin, Vittinghoff, & Shlipak, 2003; Tareen, Zadshir, Martins, Pan, Nicholas & Norris, 2005; Norris & Nissenson, 2008; Powe, 2003); and obesity (Ogden et al., 2006), among others. African Americans in rural populations are particularly vulnerable. In the Eight Americas Study of U.S. health disparities (Murray, Kulkarni, & Ezzati, 2005), low income African Americans in rural communities represent one of the described Americas – 5.8 million of the nation’s population – with an average annual income second lowest among the eight different Americas defined, and the lowest percentage of high school graduates (Murray et al., 2005). Their life expectancy is the lowest of all eight groups. Although this is the case, this group and others with high mortality do not have the worst levels of all identifiable risk factors or access to care, indicating that the explanations for the disparities in health are complex. Health disparities vary based on ethnicity, time, geographic location and outcome across the United States pointing to the complexity of potential psychosocial and physiological pathways and contributors (Adler & Rehkrophf, 2008). NIH-PA Author Manuscript Adequately addressing health outcomes among African Americans that effectively reduces and ultimately eliminates health disparities will require collaborative, multi-faceted strategies (Adderley-Kelly & Green, 2005). Diverse sectors of the community must be involved, through non-traditional partnerships and by using culturally competent participatory action methodologies (Adderley-Kelly and Greene, 2005). An increasing number of public health scientists and practitioners have begun using community-based settings for health promotion activities and interventions targeting high risk groups and hard-to-reach populations (Holt et al., 2009). Churches have been popular community organizations for health promotion programs and research studies targeting African American populations (Flegal, Carroll, Ogden & Johnson, 2002; Stecker, Fortney, Steffick, & Prajapati, 2006; Wimberly, 2001; Resnicow et al., 2000), frequently serving as the first source of support for health promotion in low-income and minority communities (Goldmon and Roberson, 2004; Olson, Reis, Murphy, & Gehm, J Prev Interv Community. Author manuscript; available in PMC 2014 March 09. Carter-Edwards et al. Page 3 NIH-PA Author Manuscript 1988). They are also the oldest and perhaps most stable institutions in these communities. Recent research has specified some of structural and organizational assets of churches that contribute to their popularity as settings for health promotion (Campbell, Hudson, Resnicow, Blakeney, Paxton & Baskin, 2007). Organizational change theory research implies that senior-level administrators are most influential in defining the problem and in making the decision to adopt a program (Huberman & Miles, 1984). Arguably, in the context of churches, the most critical of these are pastors because they serve as "trusted messengers" whose endorsement or support is critical to the success of health promotion interventions (Carter-Edwards, Johnson, Jr., Whitt-Glover, Bruce & Goldmon, in press). Research indicates that pastors with congregational health ministries were significantly more involved in health promotion and disease prevention activities than those without health ministries; however those without health ministries were willing to become involved if they had adequate resources (Catanzaro et al., 2007). In spite of these findings, it is not clear whether involvement indicated changes in their own health behaviors, which may also be important for successful health promotion within their churches. Although the relative importance of their role for conducting health promotion in church settings, no studies to date have examined rural African American pastors’ attitudes and perceptions about their churches’ health promotion organizational capacity. To this end, we conducted an exploratory pilot study and preliminarily analyzed data from a sample of African American pastors and associate pastors who lead rural congregations to describe how these key leaders perceive their churches as advocates for health promotion and as catalysts that contribute to the prevention and treatment of chronic diseases in their respective communities. NIH-PA Author Manuscript METHODS Pilgrimage to Wellness Exploratory Study: Purpose and Design NIH-PA Author Manuscript The Pilgrimage to Wellness Exploratory Study was designed to assess pastors’ or associate pastors’ perceptions and attitudes about the capacities of their churches as organizations for promoting their health and the health of the congregation, in order to ultimately: a) identify specific characteristics that may be necessary for the sustainability of health promotion programs and activities within their churches; and b) subsequently measure their impact on clergy and church members’ health behaviors and outcomes. The focus is on African American pastors of predominantly African American churches. Clergy were recruited from an urban area (Durham, NC) and from rural counties in Eastern NC. Pastors were initially invited to participate by completing a survey either via the Internet or a mailed survey. They could appoint an associate pastor or clergy to complete it on behalf of their church if they were unable to do so. Only one survey was submitted per church. The majority of clergy successfully reached and consented completed the survey (or had the survey completed) via mail or at an information meeting with the research team. The current pilot study targets the African American clergy in Eastern NC who are members of the Community Empowerment Network. Community Empowerment Network: Brief Description The Community Empower Network (CEN), which started under Success Dynamics Community Development Corporation (SDCDC) in 2005, is a collaboration of faith-based organizations originating in eastern North Carolina. CEN’s mission is to advance their communities through partnerships that thrive on economic development, superior education, and the elimination of health disparities. CEN was established in 2005 through support from the North Carolina Office of Minority Health and Health Disparities (NCOMHHD). This support allowed CEN to receive funding to help its member organizations establish wellness centers, develop health ministries, train lay health workers, and provide health screenings. CEN conducts a series of programs, including a leadership project designed to enhance J Prev Interv Community. Author manuscript; available in PMC 2014 March 09. Carter-Edwards et al. Page 4 NIH-PA Author Manuscript skills of faith-based leaders and increase the organizational capacity of churches to engage their members and communities in the civic process so that they can be equipped to mobilize change. One of the signature programs of NCOMHHD, the Community Health Ambassador Program (CHAP) (Pullen-Smith et al., 2008), started as a pilot program from this SDCDCNCOMHHD partnership and currently operates in more than fifteen of the CEN churches by providing health screenings for diabetes and other health disparities. At the time of this Pilgrimage to Wellness exploratory pilot study, there were 40 CEN member churches in 15 rural counties in Eastern North Carolina. To date, the membership continues to grow, in rural Eastern North Carolina and in other, more urban counties, with the intent to expand across the entire state. Analysis Sample Of the 40 Community Empowerment Network (CEN) member pastors invited to participate, 28 (70%) pastors or their associate pastors or ministers completed the survey. One respondent was excluded from analysis due to missing demographic data. Thus, the analysis sample included 27 (67.5%) respondents who were members of the CEN. Variable Measurement NIH-PA Author Manuscript Variables measured in this sample for this study included: clergy and church demographics; perceptions of church capacity, health ministry and church priorities and existing resources; and perceived impact of church and family on clergy’s health. Clergy demographics measured were age, gender, marital status, educational attainment, church role, work status beyond church role, and years as clergy or ministerial leader. Measures also included perceptions of own health, such as existing health conditions and perceived impact of church on personal health. Church demographics included church size (less than 100, 100–299, or 300+ members, both on the roster and active (members who attend at least monthly)). Perceptions of church capacity included the most important role of churches in terms of primary or secondary prevention, greatest health concern and health promotion barrier for their church, first/immediate health promotion action their church should take, measures of perceived importance and existence of health ministry attributes categorized into four areas: church function, leadership and staffing, technology and funding, and collaboration (CarterEdwards et al., 2006). Negative percent differences reveal health attribute need, and positive percent differences reveal there is no need to improve access to the attribute. The larger, negative percent differences reveal the greatest perceived need based on what the pastors perceive as most important and what they believe exists in their church. NIH-PA Author Manuscript Analyses Analyses included means and percent frequency statistics for the variable measures. McNemar’s test of differences in percents were used to compare the percent differences between the importance of a health ministry attribute and whether it exists in the pastors’ church (to assess attribute of greatest need, as defined by the clergy themselves). This study was approved by an Institutional Review Board at the Duke University Medical Center. RESULTS For the clergy sampled, 85% were senior pastors, 4% associate pastors, and 11% other clergy/ministerial staff (not specified). The mean age was 51.6 years. The majority was male, married, with a college education, and had an average of 15 years of pastoral experience, with a mean of 12 years at their current church (Table 1). Approximately 60% of the sample held another job outside of the church. Regarding personal health, the majority rated their health as very good (44%) or good (41%); however, they also reported they were J Prev Interv Community. Author manuscript; available in PMC 2014 March 09. Carter-Edwards et al. Page 5 NIH-PA Author Manuscript overweight (56%), had hypertension (41%), had high cholesterol (26%), and diabetes (19%). Twenty-six percent of the sample reported having none of these chronic diseases (Table 1). Of the 74% who reported having a health condition, 40% reported having two or three of the health conditions, and 10% reported having all four conditions. When asked whether church members had a major impact on their health behavior as clergy, two-thirds agreed or strongly agreed. For the quality of that impact, 67% reported it as positive or very positive, yet 15% reported it as negative or very negative. Eighty-nine percent of the clergy believed that improving church health promotion would improve their own physical health. NIH-PA Author Manuscript Table 2 presents the findings on the church characteristics and pastors’ perception of church’s capacity to promote health. Size of church membership (for those who reported) was primarily less than 300 members, whether the membership on the roster or the active membership (those that attend church at least once a month). Approximately two-thirds of the sample reported that their church has a health ministry, and of those that responded, 65% have a health ministry that is less than 5 years old. When asked “what is the most important role churches should play right now in promoting health in their congregations,” just over half of the sample (56%) selected primary prevention efforts (assisting members in the prevention of health problems); however 41% selected secondary prevention efforts (assisting members with existing health problems to improve or maintain their health). The most common activity selected to address churches’ role in health promotion was conducting health programs and classes (96%), followed by display of health education materials (59%), referral of members to health resources (56%), provide one-to-one health management (56%), and implementation of church health policy (37%). For the greatest physical health concern in their churches, pastors most commonly selected hypertension and obesity. The most common first actions churches should take are building partnerships with helpful organizations (collaborative external partnerships) (37%) and serving healthier food at church functions (22%). However, when asked about level of preparedness to actively promote health, 59% reported their churches were either somewhat prepared or not prepared at all. NIH-PA Author Manuscript Regarding health ministry attributes, those for which over 80% of the clergy reported as very important included: receipt of foundation or government funds for operating their health ministries; obtaining a separate, non-profit business status (501c3) for their outreach ministry; health ministry working with the kitchen committee; health ministry keeping a system for tracking members’ health; health fairs for members; and display of health information within the church (Table 3). For the percent difference between importance and existence in their church (as a measure of perceived need), attributes revealing the largest, statistically significant difference were: church willingness to receive foundation (−59.3%) or government (−51.9%) funds (both p≤0.0001); health ministry working with the kitchen committee (−40.8%, p=0.003); and the church having a separate non-profit business status for outreach ministries (−25.9%, p=0.039). DISCUSSION Results indicate that, in this exploratory sample of African American clergy from churches located in rural eastern NC, there is a perceived need to increase the capacity of their churches to promote their health and that of their congregations. There are also perceived financial and infrastructural challenges that need to be addressed to increase this capacity. Internal and external collaborative partnerships (i.e., kitchen committee working with the health ministry, and partnerships with outside organizations, respectively), and the offering of health programs and classes are apparent ways their churches can readily promote better health, whether through prevention of disease or disease-related complications. J Prev Interv Community. Author manuscript; available in PMC 2014 March 09. Carter-Edwards et al. Page 6 NIH-PA Author Manuscript Overall, clergy felt that their church had a major impact on their own behavior, and the quality of that impact varied (from very positive to very negative). However, regardless of perceived impact, the majority believed that improving health promotion within their church would improve their own physical health, for which nearly three-quarters reported the presence of at least one chronic health condition (Table 1). Yet, self-rated health was quite favorable. These findings are similar to those reported on the 883 clergy in the Pulpit and Pew Study on church leadership (Carroll, 2006). For the African American clergy, who represented 16% of that sample, over 85% rated their health as favorable (excellent, very good, or good); however over 82% were classified as being overweight (based on selfreported weight and height), and at least 50% also reported having hypertension, diabetes, and/or high cholesterol. Although this disconnect between self-rated health and reported health conditions would be viewed as a lack of awareness of their health conditions, the data imply that clergy in the current study (as well as the Pulpit and Pew Study) acknowledge room for improvement in personal health behaviors through improved church infrastructure. Additionally, other factors in the current study, such as dual jobs (59% of the sample) may impose levels of stress on clergy such that elements of the church environment and time requirements for clergy may exacerbate the impact of the general church environment on their health. Thus, these relationships are complex and have yet to be explored in detail. NIH-PA Author Manuscript NIH-PA Author Manuscript Health ministries are organized to address health needs through activities and information dissemination related to health and wellness (Carter-Edwards et al., 2006; Westberg, 1990). For the current study, building or bolstering health ministries were clear desires of the clergy. Although nearly two-thirds of the sample reported that their churches have a health ministry (one indicator of health promotion capacity), most have been in existence for less than five years, which corresponds with their perceived lack of preparedness of their churches to promote health. Additionally, in response to what is deemed most important on which churches should focus, over 40% of clergy reported secondary prevention, indicating a need for churches to better address the current health conditions of its members, almost as much as keeping other members from developing diseases in the first place (i.e., primary prevention, which was 55% of the sample). Nearly 75% reported hypertension or obesity as the greatest physical health concerns for their churches. So, lack of blood pressure control still remains a public health problem, despite national efforts to increase awareness, the availability of anti-hypertension therapy, and public health efforts to improve lifestyle. Obesity is an increasing concern (Flegal et al., 2002) and, in most cases, a modifiable risk factor that can, in part, be addressed through improved food choices in churches. Not surprisingly, among the clergy surveyed, conducting health promotion programs, displaying health education materials, building partnerships with outside organizations, and serving healthier food at church functions were the prevailing ways and actions by which their churches could promote health. However, the fact that many clergy listed conducting health promotion programs and displaying health education materials, and given the concern about the high prevalence of conditions such as hypertension and obesity, indicates continued need to promote community awareness. This may be particularly important in rural communities, where information and healthcare access can be limited. Building active, collaborative partnerships will become increasingly more important, particularly in today’s economy, as resources will need to be shared and innovative opportunities to work together will need to be created. This means that more efforts will have to focus on building church infrastructure to promote health. Bishop Blake of West Angeles Church of God in Christ in Los Angeles stated, in the context of describing mega-churches, “A church can grow as long as the organizational structure is in place” (Mamiya, 2006). This may also apply for smaller churches attempting to build or enhance their health ministries. Regarding serving healthier food, improving dietary outputs of African American church kitchens, specifically increased fruit and vegetable offerings was also found in the Black Churches United for Better Health Study (Glanz & Yaroch, 2004). Other preliminary studies also indicate that working with J Prev Interv Community. Author manuscript; available in PMC 2014 March 09. Carter-Edwards et al. Page 7 church auxiliary members to improve food offerings within the church can lead to lower weight among members (Carter-Edwards et al., 2005). NIH-PA Author Manuscript NIH-PA Author Manuscript Funding and improved communication within the church (i.e., kitchen committee working with the health ministry) appear to be the health ministry attributes of greatest perceived needs (Table 3). Concern for adequate funds to conduct the work of the church is not new (Lincoln and Mamiya, 1990). The challenge of doing such work without funding means clergy and their churches are almost totally dependent on volunteer staff, which may be limited in long-term effectiveness. There is criticism for accepting government grants (Mamiya, 2006). However, it may be necessary to do so. Large churches may have the capacity to handle the paperwork necessary to apply for this type of funding. What this may mean for small, rural churches is that collaboration between churches to identify common areas for pursuing funding may be essential (Carter-Edwards, Johnson, Jr., Whitt-Glover, Bruce & Goldmon, in press). It also suggests opportunity for universities to expand the nature and functions of partnerships with churches and clergy in identifying areas where the transfer of existing knowledge regarding (health care and health promotions) can be adapted to daily use by clergy and health ministries to inform members and communities. For example, such collaboration would likely be effective in obtaining funding to develop podcasts of different disease topics such as diabetes, strokes, etc. to be used by health ministries as programmatic content. Likewise, clergy and communities may have to specifically seek out individuals and organizations that can provide the technical expertise to assist in obtaining grant funding. Multiple strategies will have to be developed and implemented to address the challenges of building organizational capacity and obtaining the necessary resources to sustain and grow health ministries. It should be noted that CEN has begun to address and respond to the needs and challenges of clergy by offering a series of workshops for clergy and church members to help enhance or introduce grant writing skills. Other areas of professional development training include an understanding of key components of board development, organizational development, financial management, budgeting, and community capacity. Building skills in these areas can help clergy engage in more intentional organizational capacity efforts that may impact health outcomes of churches. Regarding improved internal communication, there needs to be a clearer understanding of the operations and structures of the kitchen committees and health ministries within the churches, whether the structures are formal or informal. If there is no health ministry and/or no kitchen committee, efforts may be necessary to establish such committees to simply begin active promotion of health. NIH-PA Author Manuscript Results from this report should be interpreted with caution. The sample size was small and may not be representative of other clergy in the area. However, 67.5% of the CEN membership participated. Limited financial resources were used to recruit clergy. With additional resources and time, it is possible that the participation rate would have increased. Secondly, the prevalence of chronic conditions for the clergy as well as their congregations are self-reported and cannot be validated at this time. Future studies need to be designed, not only to capture clinical data to assess association between organizational structure and health outcomes, but also to equip churches with health information for them to use to help monitor the impact of their programs and activities on improving the health of their congregations. Church health promotion capacity is a key concern and challenge for this sample of African American clergy from rural churches in NC. Central to the challenge of health promotion is the need for capacity building, within individual churches and collectively, as a group of organizations like CEN. While CEN collectively has made great strides towards developing organizational capacity, there is still the challenge of connecting the churches with existing J Prev Interv Community. Author manuscript; available in PMC 2014 March 09. Carter-Edwards et al. Page 8 NIH-PA Author Manuscript resources in the community and region. The need for more intentional partnership development and collaboration has never been greater, as the financial resources are more difficult to access and, for CEN and other rural churches, having the talent and expertise to prepare the necessary paperwork to get funding. The opportunity in this challenge is for more intentional collaboration with universities in the regions who have the knowledge and technical expertise needed to assist with the knowledge transfer and skills development of clergy and their health ministries. This study is one of the initial steps necessary in identifying the common organizational issues that need to be defined and addressed. Further study within this population will be important in building both individual and collaborative church organizational models to implement programs and activities that effectively mobilize members towards improved health behaviors within the church and in their communities, thereby diminishing health disparities that impact many African Americans. Acknowledgments NIH-PA Author Manuscript The authors would like to thank the clergy of the Community Empowerment Network (CEN) for their participation in this pilot study. The authors also thank the NC Office of Minority Health and Health Disparities (NCOMHHD) for its support of CEN. This research was supported in part by pilot funds provided to the Duke Center for Spirituality, Theology, and Health by the Templeton Foundation. Dr. Carter-Edwards’ efforts were also supported in part by a Clinical Translational Science Award (CTSA) administrative supplement grant from the National Center for Research Resources (NCRR), 3UL1RR024128-03S2. REFERENCES NIH-PA Author Manuscript Adderley-Kelly B, Green P. Strategies for successful conduct of research with low-income African American populations. Nursing Outlook. 2005; 53(3):147–152. [PubMed: 15988452] Adler NE, Rehkropf DH. U.S. disparities in health: Descriptions, causes, and mechanisms. Annual Review of Public Health. 2008; 29:235–252. Boudreaux ED, Emond SD, Clark S, Camargo C. Acute asthma among adults presenting to the emergency department: The role of race/ethnicity and socioeconomic status. Chest. 2003; 124(3): 803–312. [PubMed: 12970001] Bruce MA, Beech BM, Sims M, et al. Social environmental stressors, psychological factors, and kidney disease. Journal of Investigative Medicine. 2009; 57:583–589. [PubMed: 19240646] Campbell MK, Hudson MA, Resnicow K, Blakeney N, Paxton A, Baskin M. Church-based health promotion interventions: Evidence and lessons learned. Annual Review of Public Health. 2007; 28:213–234. Carroll, J. God’s potters: Pastoral leadership and the shaping of congregations. Grand Rapids, MI: Eerdmans Publishing Co.; 2006. Carter-Edwards L, Gooden KM, Amamoo MA, Din-Dzietham R. Lay nutrition education program has positive impact on weight loss: The Churches improving Health through Auxiliary and Spousal Education (CHASE) pilot study. Obesity Research. 2005; 13(Suppl):A87. Carter-Edwards L, Jallah Y, Goldmon M, Roberson JT, Hoyo C. What health ministry attributes are important and which ones exist in African American churches? An exploratory survey. North Carolina Medical Journal. 2006; 67(5):345–350. [PubMed: 17203634] Carter-Edwards L, Johnson, Whitt-Glover Bruce, Goldmon M. Health promotions for the elderly: Training black clergy in entrepreneurial spirituality. Journal of Religion and Spirituality in Social Work. 2011; 30(1) in press. Catanzaro AM, Meador KG, Koenig HG, Kuchibhatla M, Clipp EC. Congregational healh ministries: a national study of pastors’ views. Public Health Nursing. 2007; 24(1):6–17. [PubMed: 17214648] Cunningham W, Mosen D, Morales L, Andersen R, Shapiro M, Hays R. Ethnic and racial differences in long-term survival from hospitalization for HIV infection. Journal of Health Care for the Poor and Underserved. 2000; 11(2):163–178. [PubMed: 10793513] J Prev Interv Community. Author manuscript; available in PMC 2014 March 09. Carter-Edwards et al. Page 9 NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Fields LE, Burt VL, Cutler JA, Hughes J, Roccella EJ, Sorlie P. The burden of adult hypertension in the United States 1999 to 2000: A rising tide. Hypertension. 2004; 44:398–404. [PubMed: 15326093] Flegal K, Carroll M, Ogden C, Johnson C. Prevalence and trends in obesity among us adults, 1999– 2000. Journal of the American Medical Association. 2002; 288(14):1723–1727. [PubMed: 12365955] Glanz K, Yaroch A. Strategies for increasing fruit and vegetable intake in grocery stores and communities: Policy, pricing and environment. Preventive Medicine. 2004; 39:S75–S80. [PubMed: 15313075] Goldmon M, Roberson J. Churches, academic institutions, and public health: Partnerships to eliminate health disparities. North Carolina Medical Journal. 2004; 65(6):368–372. [PubMed: 15714728] Harris M, Eastman R, Cowie C, Flegal K, Eberhardt M. Racial and ethnic differences in glycemic control of adults with type 2 diabetes. Diabetes Care. 1999; 22(3):403–408. [PubMed: 10097918] Heckler, M. Report of the Secretary’s Task Force on Black and Minority Health. Washington DC: US Dept. of Health and Human Services; 1985. Hertz RP, Unger AN, Cronell JA, Saunders E. Racial disparities in hypertension prevalence, awareness, and management. Archives of Internal Medicine. 2005; 165:2098–2104. [PubMed: 16216999] Holt CL, Wynn TA, Southward P, Litaker M, Jeames S, Schulz E. Development of a spiritually based educational intervention to increase informed decision making for prostrate cancer screening among church attending African American men. Journal of Health Communication. 2009; 14(6): 590–604. [PubMed: 19731129] Hsu C-Y, Lin F, Vittinghoff E, Shlipak MG. Racial differences in the progression from chronic renal insufficiency to end-stage renal disease in the United States. Journal of the American Society of Nephrology. 2003; 14:2902–2907. [PubMed: 14569100] Huberman, AM.; Miles, MB. Innovation up close: How school improvement works. New York: Plenum; 1984. Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer Statistics, 2007. CA: A Cancer Journal for Clinicians. 2007; 57:43–66. [PubMed: 17237035] Kravitz R. Ethnic differences in use of cardiovascular procedures: New insights and new challenges. Annals of Internal Medicine. 1999; 130(3):231–233. [PubMed: 10049202] Lincoln, CE.; Mamiya, LH. The Black church in the African American experience. Durham, NC: Duke University Press; 1990. Lloyd-Jones D, Adams R. Heart disease and stroke statistics- 2009 update: A report from the American Heart Association Statistics Committee and Stroke Statistics subcommittee. American Heart Association. 2009 Mamiya, L. Pulpit and Pew: Research on pastoral leadership. Durham, NC: Duke Divinity School; 2006. River of struggle, river of freedom: trends among Black churches and Black pastoral leadership. Murray C, Kulkarni S, Ezzati M. Eight Americans. New perspectives on US health disparities. American Journal of Preventive Medicine. 2005; 29(5):4–10. [PubMed: 16389119] Norris K, Nissenson AR. Race, gender, and socioeconomic disparities in CKD in the United States. Journal of the American Society of Nephology. 2008; 19(7):1261–1270. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. Journal of the American Medical Association. 2006; 295(13):1549–1555. [PubMed: 16595758] Olson LM, Reis J, Murphy L, Gehm JH. The religious community as a partner in health care. Journal of Community Health. 1988; 13(4):249–257. [PubMed: 3235715] Powe NR. To have and have not: health and health care disparities in chronic kidney disease. Kidney International. 2003; 64:763–772. [PubMed: 12846781] Pullen-Smith B, Carter-Edwards L, Leathers K. Community health ambassadors: A model for engaging community leaders to promote better health in North Carolina. Journal of Public Health Management and Practice. 2008; 14(6):S73–S81. [PubMed: 18843243] J Prev Interv Community. Author manuscript; available in PMC 2014 March 09. Carter-Edwards et al. Page 10 NIH-PA Author Manuscript Resnicow K, Wallace DC, Jackson A. Dietary change through African American churches: Baseline results and program description of the Eat for Life trial. Journal of Cancer Education. 2000; 15(3): 156–163. [PubMed: 11019764] Saaddine J, Engelgau M, Beckles G, Gregg E, Thompson T, Narayan K. A Diabetes report card for the United States: Quality of care in the 1990s. Annals of Internal Medicine. 2002; 136(8):565–574. [PubMed: 11955024] Smith LA, Hatcher-Ross JL, Wertheimer R, Kahn RS. Rethinking race/ethnicity, income, and childhood asthma: Racial/ethnic disparities concentrated among the very poor. Public Health Representative. 2005; 120(2):109–116. Stecker T, Fortney JC, Steffick D, Prajapati S. The triple threat for chronic disease: obesity, race, and depression. Psychosomatics. 2006; 47:513–518. [PubMed: 17116953] Tareen N, Zadshir A, Martins D, Pan D, Nicholas S, Norris K. Chronic kidney disease in African American and Mexican American populations. Kidney International. 2005; 68(Supplement 97):S137–S140. [PubMed: 16014092] Westberg, GE. The parish nurse: providing a minister of health for your congregation. Minneapolis, MN: Augsburg Publications; 1990. Wimberly, DW. Health issues in the Black community. San Francisco: Jossey-Bass; 2001. Zoratti EM, Havstad S, Rodriguez J, Robens-Paradise Y, Lafata JE, McCarthy B. Health service use by African Americans and Caucasians with asthma in a managed care setting. American Journal of Respiratory Critical Care Medicine. 1998; 158(2):371–377. [PubMed: 9700109] NIH-PA Author Manuscript NIH-PA Author Manuscript J Prev Interv Community. Author manuscript; available in PMC 2014 March 09. Carter-Edwards et al. Page 11 Table 1 Pastor Characteristics (n=27) NIH-PA Author Manuscript Characteristic Value Age (yrs) Mean (SD) 51.6 (±8.3) Range 33–69 Gender Male 81% Female 19% Marital Status Married 81% Single/Divorced/Widowed 19% Education NIH-PA Author Manuscript ≤ High School Diploma 15% Some College 33% College or Graduate Degree 52% Church Role Senior Pastor 85% Associate Pastor 4% Other Minister (unspecified) 11% Other Job Outside of Church Yes 59% No 41% Tenure as Pastor/Associate Pastor Mean (SD) Years Total (n=25) 14.7 (±7.9) Mean (SD) Years at Current Church (n=27) 12.3 (±8.0) Self Rated Health NIH-PA Author Manuscript Excellent 7% Very Good 44% Good 41% Fair 4% Missing 4% Reported Medical Conditions (n=27)* Overweight 56% Hypertension 41% Diabetes 19% High Cholesterol 26% None 26% Number of Reported Medical Conditions (n=20) One Condition 50% J Prev Interv Community. Author manuscript; available in PMC 2014 March 09. Carter-Edwards et al. Page 12 Characteristic Value NIH-PA Author Manuscript Two Conditions 20% Three Conditions 20% Four Conditions 10% Church Has Major Impact on Own Health Behavior Strongly Agree 33% Agree 33% Disagree 26% Strongly Disagree 4% Missing 4% Quality of Church Impact on Own Health Behavior NIH-PA Author Manuscript Very Positive 19% Positive 48% Negative 11% Very Negative 4% Don’t Know 4% Not Applicable 4% Missing 11% Improving Church Health Promotion Would Improve Own Physical Health Yes 89% No Improvement Needed 7% Don’t Know 4% * Respondents may have more than one condition. NIH-PA Author Manuscript J Prev Interv Community. Author manuscript; available in PMC 2014 March 09. Carter-Edwards et al. Page 13 Table 2 Church Characteristics and Perceived Health Promotion Capacity (n=27) NIH-PA Author Manuscript Characteristic Value Reported Church Size – Total on Roster Less than 100 Members 19% 100–299 Members 30% 300 or more Members 19% Missing 33% Reported Church Size – Active Roster* Less than 100 Members 37% 100–299 Members 30% 300 or more Members Missing 7% 26% Existence of a Health Ministry NIH-PA Author Manuscript Yes 63% No 37% Length of Time Health Ministry has Existed in the Church Less than 5 Years 65% 5 Years of More 35% Most Important Role of Churches Assist in Promoting Primary Prevention 56% Assist in Promoting Secondary Prevention 41% Missing 4% Ways to Promote Role Within the Church** Conduct Health Programs and Classes 96% Display Health Education Materials 59% Refer Members to Health Resource 56% Provide one-on-one Health Management 56% Implement Church Health Policy 37% NIH-PA Author Manuscript Other (not specified) 7% Greatest Physical Health Concern of Own Church*** Hypertension 44% Obesity 30% Diabetes 19% No Answer 7% Greatest Barrier to Promoting Better Health Not Enough Funding 37% Not Having a Health Ministry 22% A Disconnect Between Physical and Mental/Spiritual Health 19% J Prev Interv Community. Author manuscript; available in PMC 2014 March 09. Carter-Edwards et al. Page 14 Characteristic Value Not Enough Volunteers to Lead 11% NIH-PA Author Manuscript Not Enough Time for Pastors to Address 4% Other Barrier**** 4% Missing 4% First Action Church Should Take to Promote Health Build Partnerships with Helpful Outside Organizations 37% Serve Healthier Food at Church Functions 22% Start Physical Activity Programs within the Church 11% Incorporate Health Messages in Sermons 7% Incorporate Health Messages in Bible Studies 7% Raise Funds to Support Health Promotion 7% Implement Sustainability Plan for Current Health Services 4% Other (not specified) 4% Preparedness of Church to Actively Promote Health NIH-PA Author Manuscript Very Prepared 19% Prepared 22% Somewhat Prepared 37% Not Prepared at All 22% Note: For characteristics above, sums of percents not equal to 100% are a result of rounding. * Attend church monthly ** Respondents could choose as many methods as desired. *** Cancer and HIV were also listed as response choice options in the survey, but not selected by respondents. **** Other barriers included health insurance and provider access. NIH-PA Author Manuscript J Prev Interv Community. Author manuscript; available in PMC 2014 March 09. NIH-PA Author Manuscript View publication stats J Prev Interv Community. Author manuscript; available in PMC 2014 March 09. Function Health ministry occasionally provides members transportation to physician offices or health centers Members have access to internet at church Function Leadership and Staffing Technology and Funding Pastor appoints member to lead health ministry Pastor incorporates health messages in sermons monthly Leadership and Staffing Health ministry is headed by a healthcare professional Function Church displays health information (pamphlets) Leadership and Staffing Pastor leads ministry and makes all of the decisions Function Technology and Funding Pastor has access to internet at church Health messages/announcements are in Sunday bulletins at least once per month Function Church hosts health fairs for members 74.1 63.0 77.8 59.3 88.9 70.4 14.8 74.1 70.4 51.9 33.3 55.6 63.0 63.0 44.4 40.7 63.0 44.4 37.0 29.6 % Exist 63.0 55.6 70.4 51.9 81.5 74.1 18.5 77.8 81.5 63.0 44.4 66.7 77.8 81.5 63.0 66.7 88.9 85.2 88.9 88.9 % Very Important 11.1 7.4 7.4 7.4 7.4 −3.7 −3.7 −3.7 −11.1 −11.1 −11.1 −11.1 −14.8 −18.5 −18.6 −25.9 −25.9 −40.8 −51.9 −59.3 Difference in %* 0.549 0.688 0.688 0.754 0.688 1.000 1.000 1.000 0.453 0.453 0.629 0.581 0.289 0.180 0.227 0.092 0.039 0.003 0.0001 <0.0001 pvalue** McNemar's test of differences in percents of very important and exist in church. Bolded p-values indicate where there is a significant difference between what pastors deem important and what they actually have at their church. ** Differences in percents of perception of attribute as very important compared to its existence in the church. Measures perceived need of attribute, where the more negative the difference the greater the need. * Function Health ministry uses biblical scripture with members Collaboration Function Church hosts health fairs for the community Church participates in research with local community organizations Function Technology and Funding Health ministry has system for keeping track of members’ health Church has earmarked funds for health ministry Collaboration Technology and Funding Church has separate 501c3 for outreach ministries Church participates in research studies with universities Leadership and Staffing Technology and Funding Church is willing to receive government funds for its health ministry Health ministry works with the kitchen committee Technology and Funding Church is willing to receive foundation funds for its health ministry Attribute Attribute Area NIH-PA Author Manuscript Perceived Importance and Existence of Health Ministry Attributes (n=27) NIH-PA Author Manuscript Table 3 Carter-Edwards et al. Page 15