Abstract
Background:
Churches are important assets for the African American and Latino community. They can play a critical role in health promotion, especially in areas that are under-resourced and in which residents have limited access to health care. A better understanding of health promotion in churches is needed to support and maintain church collaborations and health initiatives that are integrated, data-driven and culturally appropriate. The purpose of this study is to identify churches’ facilitators and challenges to health promotion, and to contrast and compare Black and Latino churches of different sizes (<200 members versus ≥ 200 members).
Methods:
We interviewed leaders of 100 Black and 42 Latino churches in South Los Angeles to assess their history of wellness activities, resources, facilitators and challenges to conduct health promotion activities.
Results:
83% of African American and 86% of Latino church leaders reported at least one health activity in the last 12 months. Black and Latino churches of different sizes have similar interests in implementing specific health promotion strategies and face similar challenges. However, we found significant differences in the composition of their congregations, number of paid staff, and the proportions of churches that have a health or wellness ministry and that implement specific wellness strategies. 57% of African American and 43% of Latino church leaders stated that they needed both financial support and professional expertise for health promotion.
Discussion:
Our findings highlight the importance of conducting a readiness assessment for identifying intervention content and strategies that fit the intervention context of a church.
Keywords: Black and Latino churches, readiness assessment, survey of senior pastors, wellness promotion, health promotion
Background
Churches are important institutions in the Black and Latino communities. After the Civil War, a large number of Black churches were established in the South that served as primary institutions for social cohesion in the African American community. Since that time, many Black churches have supported leadership development, schools, civic engagement and economic opportunities for members of the Black community [1]. Churches also provide important social networks in the Latino community. They are often attended by multi-generational families that may also include undocumented immigrants. Research suggests that religious resources in this community can be leveraged to reduce health disparities [2].
Churches have long been involved in a large variety of health promotion and public health interventions [3–8]. This is consistent with the Social Ecological Framework, which recognizes that individuals are part of families that belong to organizations and social groups, live in neighborhoods and communities, and are influenced by broad environmental, cultural and social forces [9, 10]. The role of churches may be especially important in areas that are under-resourced and in which residents have limited access to health care providers. South Los Angeles (LA) is one of these areas. Its population is 68% Latino and 27% African American; 52% of adults are foreign-born and 33% of adults report difficulty accessing medical care [11].
As churches can engage in health promotion that can impact health and health disparities, it is imperative to understand the facilitators and challenges that they experience, their resources, interests and needs regarding the implementation of health promotion activities. One of many health promotion theories is the Consolidated Framework for Implementation Research that provides structure to the many factors that can influence the implementation effort [12]. Although this framework comprises five major domains (characteristics of the intervention itself, of the inner and outer settings, the individuals involved, and the implementation process), our study is limited to the inner setting factor of readiness related to health promotion. Readiness reflects broadly the degree to which an organization is willing and prepared to address an issue, as perceived by those who complete the assessment [13]. According to the Theory of Organizational Readiness for Change, organizations with high readiness for change are more likely to initiate change, such as health promotion activities, and exert greater effort and persistence to conduct these activities, which results in more effective implementation [13]. Constructs of readiness include structural characteristics (e.g., size of congregation), resources, facilitators and challenges to conduct health promotion. Prior studies have assessed the readiness of Black or Latino churches to promote wellness [14–18],, which does not allow for a direct comparison..
A better understanding of health promotion in churches is needed to support and maintain church collaborations and health initiatives that are integrated, data-driven and culturally appropriate and have the potential to improve community health [19]. We interviewed leaders of both Black and Latino churches in South LA. The purpose of this analysis is to identify facilitators and challenges to health promotion that these churches experience and to contrast and compare Black and Latino churches of different sizes. We were especially interested in learning about the needs and interests with respect to health promotion in churches with more than 1,000 members, since they have the potential to reach a large number of individuals. We are using Latino and Hispanic (abbreviated H in tables) interchangeably.
Methods
Instrument development
We developed a readiness assessment based on prior studies and theoretical formulations [12, 13, 15, 20–22] and in collaboration with four African American ministers and health ministry leaders. First we identified existing items from available instruments [15, 23] or modified existing items for our assessment. Then we discussed this initial item pool with our community partners. They recommended to justify the need for this assessment by explaining health disparities in South LA to church leaders and to have a mix of open-ended and closed-ended questions to give church leaders the opportunity to explain the special circumstances at their respective churches in their own words (see more details in [16]. Subsequently, the assessment was translated into Spanish. Pilot testing with 3 Latino church leaders resulted in a few minor modifications. Church leaders in both communities considered the content of the assessment suitable, thus establishing face validity.
The final questionnaire was 10 pages (see supplementary file). Using a mix of open-ended, yes/no and Likert scale questions, we assessed churches’ history of wellness activities in the last 12 months (time frame was restricted to improve recall); resources to implement wellness activities and additional resources needed; willingness to implement a list of 14 activities; challenges to implement wellness activities; and church characteristics, including denomination, size of the congregation and number of paid staff.
Data collection
From 2017 to 2018, an African American pastor and an English-Spanish bilingual Latino health educator conducted surveys either face-to-face (32% of Black, 57% of Latino churches) or by telephone with leaders of Black (N=100) and Latino churches (N=42) in South LA. The sample sizes were unequal because the assessment was initially planned with Black churches only, but was then extended to Latino churches for a limited time period. Latino churches that offered at least one weekly service in Spanish were eligible to participate. We began by recruiting churches with which our research team had existing relationships. These churches then referred us to additional churches (snowball sampling). We were referred to several large Catholic Latino churches that also support schools and were therefore open during office hours and accessible for interviewing. We also approached 14 Latino churches that we identified online or through visits in the neighborhood. Church leaders received a $100 incentive or church donation after completion of the survey. Since we only collected church-related information, not the church leaders’ private information, the need for ethical approval was deemed unnecessary by the University of California Los Angeles Institutional Review Board because the project does not involve “human subjects” as defined in the federal regulations. Therefore, no informed consent was obtained.
Analysis
Descriptive analyses were conducted to examine church characteristics, history of health promotion activities conducted at churches, and challenges and facilitators to conduct health promotion activities using SAS 9.4. Black churches had between 10 and 800 active members and Latino churches between 28 and 3,000 active members. Both samples included 26 churches with 200 members and more, which we chose as a cut-off point to group churches by size. In a previous analysis limited to Black churches, church size (number of active members) was significantly related to the number of wellness activities conducted in the last 12 months, the number of paid staff and the presence of a health ministry [16]. Therefore, we divided churches into 4 groups for statistical comparisons: small to medium Black churches (<200 members, N=74), large Black churches (≥ 200 members, N=26), small to medium Latino churches (<200 members, N=16) and large Latino churches (≥ 200 members, N=26).
Half of the large Latino churches had more than 1,000 members. Because these churches were unique to the Latino sample and have the potential to reach a very large number of community members, we sub-divided large Latino churches into large (200 to 1,000 members, N=13) and very large (> 1,000 members, N=13) to conduct exploratory comparative analyses. All analyses were conducted using Fisher’s exact test for categorical variables and Kruskal-Wallis test for continuous variables. When comparing large and very large churches, we also report median values, due to the small sample sizes and asymmetric data distributions.
Results
Readiness assessments with 100 African American church leaders lasted between 20 and 90 minutes with a median of 45 minutes. Readiness assessments with 42 Latino church leaders lasted between 24 and 123 minutes with a median of 41 minutes; 62% were conducted in Spanish and 38% in English. Leaders of one Black and three Latino churches declined to participate.
Characteristics of Black and Latino churches
As shown in Table 1, the majority of Black churches in our sample were Baptist and the majority of Latino churches were Catholic, with statistically significant differences within each sample and by church size. Black churches that did not identify as Baptist (N=49) or Methodist (N=13) were grouped as “other” (N=38), which also includes 18 non-denominational churches. Large Black churches were significantly more likely to have a health ministry than small Black churches and compared to large Latino churches.
Table 1:
Characteristics of Black and Latino/Hispanic Churches by church size
| Black Churches (B) | Latino/Hispanic Churches (H) | S/M Churches | L Churches | |||||
|---|---|---|---|---|---|---|---|---|
| Characteristic (Mean ± s.d.) |
S/M (N=74) | L (N=26) | S/M vs L | S/M (N=16) | L (N=26) | S/M vs L | B vs H | B vs H |
| % | % | p | % | % | p | p | p | |
| Other | 45% | 15% | 38% | 12% | ||||
| Has health/ wellness ministry | 31% | 69% | .001 | 6% | 19% | .38 | .06 | .001 |
| range | 0–95 | 10–85 | 5–70 | 7–60 | ||||
| range | 0–80 | 7–90 | 10–70 | 10–85 | ||||
| range | 0–100 | 0–99 | 5–100 | 10–80 | ||||
| range | 0–13 | 3–35 | 0–6 | 1–50 | ||||
| range | 0–5 | 0–5 | 0–5 | 0–5 | ||||
| range | 1–8 | 0–8 | 0–9 | 0–9 | ||||
Kruskal-Wallis test for continuous variables, Fisher’s exact test for categorical variables.
S/M = small to medium churches (<200 members); L = large churches (200+ members); B = Black churches; H = Latino/Hispanic churches
Large Black churches had the highest proportion of elderly parishioners (median 45%). Large Latino churches had the highest proportion of young families (median 40%) and the highest proportion of commuters, who only attended weekly church services but no other activities (median 50%). The number of paid staff per church was significantly higher in large churches than in small to medium size churches in both communities; in small to medium size churches, Black churches had significantly more paid staff than Latino churches.
Wellness activities conducted by Black and Latino churches during last 12 months
On average, large Latino churches conducted 3 wellness activities in the last 12 months, whereas all other categories conducted, on average, two activities per month (p<.05, see Table 1). The vast majority, 83% of African American and 86% of Latino church leaders, reported at least one health activity in the last 12 months. As shown in Table 2, many events in both Black and Latino churches focused on increasing awareness and screening for disease and were conducted in partnerships with other entities, such as national organizations, clinics or universities. While many activities were common in both groups (e.g., dancing classes), few churches mentioned activities that suggest implementation of a health policy (e.g., Sunday school menu change).
Table 2:
Health Issues addressed by Black and Latino/Hispanic churches during the last 12 months
| Health Issues | Black Churches (N=100) | Latino/Hispanic Churches (N=42) | ||
|---|---|---|---|---|
| % | Examples of Wellness Activities | % | Examples of Wellness Activities | |
| Cancer | 45 | Mammogram van and talk on prostate cancer screening with American Cancer Society at community health fair; hosting speaker for cancer awareness/early detection; Worship in Pink during breast cancer awareness month; cancer support group; men’s breakfast to discuss prostate cancer screening; | 14 | Mammograms and Pap tests in partnership with a clinic; prostate cancer workshop offered by a university; |
| Diabetes | 17 | Table with print information at health fair; | 43 | Screening in partnership with a clinic or through American Diabetes Association; screening at a health fair; class by promotoras; |
| Cardio-vascular disease/stroke | 29 | Blood pressure screening offered together with another church at a health fair; screenings through a health center at a health fair; | 33 | Blood pressure screening in partnership with a clinic; cholesterol screening by American Heart Association or during a health fair; |
| Physical activity | 29 | Weekly dance class; Zumba; exercise during Sunday worship; walking club for seniors; gospel aerobics; | 36 | Zumba classes; hiking groups; |
| Food/nutrition | 22 | Cooking demonstrations; informational sessions; community garden; Sunday school menu change; no soda at church events; | 36 | Cooking/nutrition classes; free food distribution; community garden; |
| Mental health | 15 | Workshop on depression; Alzheimer support network; | 2 | Self-esteem support group |
| General health | 12 | Guest speakers; wellness conference; annual health fair; health tips in church newsletter; | 19 | General health checks through Parish nurse program; health fair; |
| Substance use/sobriety | 4 | Recognition of members who do not drink alcohol; | 10 | Alcoholics Anonymous; |
| Other | 16 | Flu shots at Prayer in the Park; HIV/AIDS movie screening; breast feeding seminar; | 76 | Volunteer dentist provides services; blood drive with American Red Cross; free flu shots by Los Angeles Department of Public Health or a pharmacy; Talks on different topics by doctors; free eye exams at health fair; family planning classes by promotoras; |
Table 3 summarizes strategies used by churches for health promotion, in response to yes/no questions. The majority of churches promoted good nutrition and physical activity from the pulpit and 69% had partnerships with clinics or outside resources that could assist with wellness efforts at church. However, only about half of the churches had ever partnered with an academic institution to promote wellness and fewer churches reported having guidelines for healthy church meals (42%), having a health advisory program (37%) or having health policies for their congregation (35%). Among small to medium churches, Latino churches were significantly more likely than Black churches to have a health advisory program (56% versus 22%, p=0.01). Among large churches, more Black than Latino churches reported promoting good nutrition (92% versus 54%, p=0.004) and physical activity from the pulpit (92% versus 46%, p=0.001), and having 3 or more individuals who function as wellness champions (92% versus 23%, p<0.001).
Table 3:
Wellness strategies in Black and Latino/Hispanic churches by church size
| Church has … | All N=142 | Black Churches (B) | Latino/ Hispanic Churches (H) | S/ M Churches | L Churches | ||||
|---|---|---|---|---|---|---|---|---|---|
| <200 members (N=74) | ≥200 members (N=26) | S/M vs L | <200 members (N=16) | ≥200 members (N=26) | S/M Vs L | B versus H | B versus H | ||
| % | % | % | p | % | % | p | p | p | |
| promoted good nutrition from the pulpit in last 12 months | 82 | 89 | 92 | 1.00 | 75 | 54 | .21 | .21 | .004 |
| promoted physical activity from the pulpit in last 12 months | 77 | 85 | 92 | .50 | 69 | 46 | .21 | .15 | .001 |
| partnership with clinics or outside resources that could assist in wellness efforts at church | 69 | 59 | 85 | .03 | 62 | 85 | .14 | 1.00 | 1.00 |
| conducted > 1 wellness activity in last 12 month | 61 | 50 | 3 | .06 | 56 | 85 | .07 | .78 | .50 |
| 3 or more individuals that function as wellness champions | 56 | 92 | .001 | 38 | 23 | .48 | .17 | .001 | |
| ever partnered with academic institution to promote wellness | 49 | 49 | 69 | .11 | 38 | 38 | 1.00 | .58 | .05 |
| guidelines for healthy church meals | 42 | 35 | 42 | .64 | 62 | 46 | .35 | .05 | 1.00 |
| health advisory program | 37 | 22 | 54 | .005 | 56 | 54 | 1.00 | .01 | 1.00 |
| health or wellness policies or goals for congregation | 35 | 31 | 44 | .33 | 50 | 31 | .33 | .16 | .39 |
Fisher’s exact test.
S/M = small to medium churches (<200 members); L = large churches (200+ members); B = Black churches; H = Latino/Hispanic churches
Facilitators to conduct health promotion in Black and Latino churches
While almost all churches had meeting space, classrooms or conference rooms, other resources included a kitchen (65% of Black and 86% of Latino churches), volunteers (50% of Black, 69% of Latino churches) and parking lots (9% of Black and 26% of Latino churches). A few Black churches had exercise space (15%) and three Latino churches mentioned relationships with police departments, political leaders or immigration attorneys. However, 14% of Black churches had no resources other than space, and most of these were very small churches with 20 to 50 active members.
The majority of church leaders stated that they needed both financial support and professional expertise (57% of African American and 43% of Latino church leaders). Smaller proportions stated that they only needed professional expertise (25% of African American and 26% of Latino church leaders) or only financial support (6% of African American and 14% of Latino church leaders; data not shown). For example, church leaders stated that they needed “physicians and nurses willing to serve the community” and “finances, expertise and training to do things the right way”. Twelve Black and two Latino churches specifically mentioned their need for partnerships or collaborations with outside experts (“Credible community program interested in collaboration”).
Both Black and Latino churches were most interested in obtaining the following resources: gift cards for volunteers or study participants; a list of local resources for referrals; printed health information; a list of speakers; a sample of a needs assessment for their congregation; and workshops to inform volunteers so they can pass on health information to church members. All of these resources were rated between 9 and 10 on a scale from not interested [1] to extremely interested [10] with no differences by church size.
When asked about the type of activities churches would be willing to conduct to promote health, Black and Latino churches had similar responses: They were, on average, most willing to distribute print information, conduct health fairs, partner with an academic institution to promote health, host a speaker, conduct a survey with parishioners to identify health concerns, host a health program delivered by an outside expert and help to recruit church members, promote health as part of a research study, and identify volunteers who would be trained to provide counseling (all rated >8 on a scale from 1 – not interested to 10 – extremely interested). Both Black and Latino churches were moderately willing to incorporate exercise breaks into church activities, institute policies regarding the food that can be served at church, regularly incorporate health messages in the sermon, raise funds to support a wellness activity at their church, and ask church members to give a testimonial (all rated between 6.7 and 8.3 on a 10-point scale).
Challenges to conduct health promotion in Black and Latino churches
As shown in Table 4, insufficient budget and lack of other resources were the most frequently endorsed challenges; however, lack of other resources was significantly more problematic for small to medium and for large Black churches than for Latino churches. One of the top challenges for all churches was “not sure how to implement wellness activities”. Having not enough volunteers was a particular challenge for Black churches, while “having too many activities ongoing” was a particular challenge for Latino churches. Other challenges that were less frequently endorsed were lack of interest among members, not sure what topic would be of interest, small size of the membership, and members dislike participation in research. The average number of challenges ranged from 4 to 5 in all church categories, with no significant difference between groups.
Table 4:
Black and Latino/Hispanic churches that experienced or expect barriers to implementing wellness activities by church size
| All N=142 | Black Churches (B) | Latino/Hispanic Churches (H) | S/ M Churches | L Churches | |||||
|---|---|---|---|---|---|---|---|---|---|
| <200 members (N=74) | ≥200 members (N=26) | S/M vs L | <200 members (N=16) | ≥200 members (N=26) | S/M vs L | B versus H | B versus H | ||
| % | % | % | p | % | % | p | p | p | |
| Insufficient budget | 81 | 86 | 81 | 0.53 | 69 | 73 | 1.00 | 0.13 | 0.74 |
| Lack of other resources | 68 | 82 | 77 | 0.57 | 44 | 35 | 0.74 | 0.003 | 0.005 |
| Not sure how to implement wellness activities | 65 | 61 | 62 | 1.00 | 69 | 77 | 0.72 | 0.78 | 0.37 |
| Not enough volunteers | 49 | 58 | 58 | 1.00 | 25 | 27 | 1.00 | 0.03 | 0.05 |
| Lack of commitment from church leadership |
30 | 38 | 31 | 0.64 | 12 | 19 | 0.69 | 0.08 | 0.52 |
| Too many activities already ongoing | 42 | 30 | 38 | 0.47 | 50 | 73 | 0.19 | 0.15 | 0.02 |
| Members not interested | 40 | 47 | 46 | 1.00 | 31 | 19 | 0.46 | 0.28 | 0.07 |
| Not sure what topics members would be interested in | 35 | 39 | 31 | 0.49 | 31 | 27 | 1.00 | 0.78 | 1.00 |
| Size of membership | 22 | 28 | 0 | 0.001 | 38 | 15 | 0.14 | 0.55 | 0.11 |
| Members don’t like to participate in research | 28 | 26 | 19 | 0.60 | 44 | 35 | 0.74 | 0.22 | 0.35 |
Fisher’s exact test.
S/M = small to medium churches (<200 members); L = large churches (200+ members); B = Black churches; H = Latino/Hispanic churches
Facilitators and Challenges to conduct health promotion in very large Latino churches
Very large Latino churches (>1,000 members) were significantly different from large Latino churches with 200–1,000 members in that all very large churches were Catholic compared to 54% of large churches (p=.01). As shown in Table 5, very large churches tended to have more paid staff (median 7) than large churches (median 4), but also experienced or expected more challenges (median 5 versus 3 in large churches); however, these differences were not statistically significant.
Table 5:
Differences between large and very large Latino churches
| 200–1,000 members (N=13) | >1,000 members (N=13) | p | |||
|---|---|---|---|---|---|
| N | % | N | % | ||
| Other | 3 | 23 | 0 | 0 | |
| range | (1–50) | (3–15) | |||
| Wellness Strategies implemented | |||||
| promoted physical activity from pulpit in last 12 months | 9 | 69 | 3 | 23 | 0.05 |
| promoted good nutrition from the pulpit in last 12 months | 10 | 77 | 4 | 31 | 0.05 |
| has guidelines for healthy church meals | 9 | 69 | 3 | 2% | 0.05 |
| Challenges to implement wellness activities | |||||
| Too many activities already ongoing | 8 | 62 | 11 | 85 | 0.38 |
| Not sure what topics members would be interested in | 5 | 38 | 2 | 15 | 0.38 |
| Not enough volunteers | 2 | 15 | 5 | 38 | 0.38 |
| Members not interested | 1 | 8 | 4 | 31 | 0.32 |
| Lack of commitment from church leadership | 1 | 8 | 4 | 31 | 0.32 |
| range | 1–8 | 0–9 | |||
Kruskal-Wallis test for continuous variables, Fisher’s exact test for categorical variables
Large and very large Latino churches were significantly different with respect to the implementation of the following wellness strategies: very large churches were significantly less likely than large churches to have promoted during the last 12 months physical activity (23% versus 69% of large churches) and good nutrition (31% versus 77%) from the pulpit, and only 23% of very large Latino churches had guidelines for healthy church meals compared to 69% of large Latino churches (all p<.05). There were no statistically significant differences between large and very large churches with respect to the types of challenges they experienced or expected to implement wellness activities; however, more very large churches than large churches stated that they had too many activities already ongoing, insufficient number of volunteers, members not interested and lack of commitment from church leadership.
Discussion
To our knowledge, this is the first comprehensive assessment of readiness for health promotion with both Black and Latino churches. Results of the assessment suggest that as a group, Black and Latino churches of different sizes have similar interests in implementing specific health promotion strategies and face similar challenges. However, we found significant differences in the composition of their congregations, number of paid staff, and the proportions of churches that have a health ministry and that implement specific wellness strategies. These findings complement a recent report by Derose and colleagues that describes their experience of developing a faith and public health partnership in South LA [24].
When discussing our findings, one should appreciate that health promotion is not the primary mission of the church. This may be one of the reasons that only few churches in our sample had health or wellness policies or goals for their congregation. Only a handful of faith-based interventions have encouraged policy changes, such as serving water instead of sugar-sweetened beverages or policies regarding the type of food served at church functions [25–27]. Future church interventions should attempt to integrate health policies, since even small policy changes can reach the entire congregation, may introduce new norms to the congregation and may be sustained after other intervention approaches have ended [27].
As in other church assessments [15], churches used a large number of strategies to promote wellness. Two prior surveys of Latino church leaders found that only 21 to 33% of churches had offered health programs in the last 12 months [18, 28] compared to more than 80% of Black and Latino churches in our survey. We asked in an open-ended question if churches had been involved “in any wellness activities in the last 12 months to promote mental health, better nutrition, physical activity, flu shots, cancer screening, cancer support groups, blood pressure screening, HIV/AIDS or any other health issues.” These examples may have improved recall. Differences in sample characteristics and study methodologies may contribute to these large variations in findings. Nevertheless, we believe that there is value in assessing wellness activities in the last 12 months as such an assessment can provide important information on the type of activities churches are interested to implement and that are feasible with the available resources and with resources other organizations can provide to support churches. Therefore, we recommend conducting such an assessment prior to planning church activities to promote wellness.
While many studies have shown the value of interventions that are culturally relevant for specific communities [29, 30], our findings add to the literature by describing the interests, resources and challenges of churches that can potentially implement these programs. These church attributes, which can be conceptualized as intervention context at the organization level or the inner setting of the Consolidated Framework for Implementation Research [12], can influence important components of implementation fidelity [31, 32]. Fidelity is defined as the degree to which an intervention is implemented as it was initially developed and tested in a research setting and found to be effective. Components of fidelity are delivery of the core component(s) of an intervention to which its effectiveness is attributed; delivery of the full dose such as number, length and frequency of sessions and quality of delivery; and the format of intervention delivery, e.g., phone or face-to-face [31]. A good fit between the preferences and resources of community agencies and the structure and content of wellness programs will increase the fidelity of an intervention and limit the need for changes that may have consequences for its effectiveness. A needs assessment similar to ours will be helpful for identifying interventions that fit the intervention context of a church.
Overall, large churches had more resources than small to medium churches to conduct wellness activities. However, about half of the members of large Latino churches in our sample were commuters, who may be unlikely to attend wellness activities that require extra travel. In such a case, a church may focus on raising awareness and promoting health through social media, church bulletins and during regular church services. Large Black and Latino churches also had different audiences with respect to their age distribution: Large Black churches had the highest proportion of elderly parishioners, for which information on cancer screening would be most relevant, whereas large Latino churches had a high proportion of young families, who may be more interested in primary prevention through healthy lifestyles. These are examples of how church attributes (e.g., composition of the congregation) have to be considered when selecting intervention format and content.
Our exploratory analyses of very large Latino churches suggests that they have their own set of challenges, with too many activities ongoing and not enough volunteers, and that they underutilize several health promotion strategies that are popular in large Latino churches. One reason may be that the majority of the Latino churches in our sample conduct religious services in Spanish and English, which poses a greater workload for church leaders and for planning health promotion activities in both languages.
Limitations:
Our convenience sample of churches in South LA may not be representative of all Black and Latino churches. Responses are from one leader per church and may suffer from social desirability bias. Only 13 Latino churches with more than 1,000 members were included in our exploratory analysis, which provided low statistical power.
Conclusions
Based on the results of our study, we provide the following recommendations: Health promotion planning in churches should build on prior church activities that have been shown to be feasible given available resources and that meet the interests of church leaders and members. We recommend completing a comprehensive readiness assessment prior to planning new health promotion activities in churches, as this allows church leaders to reflect on past activities and to consider the feasibility of implementing additional strategies. A readiness assessment allows church leaders to actively engage in the planning of new health promotion activities and to contribute their experiences and perspectives. With a completed readiness assessment, health promotion activities can be planned that take advantage of church resources and facilitating factors. Additional resources can be allocated to overcome identified challenges. Health promotion strategies that are aligned with churches’ capacity and interests are more likely to be successfully implemented and may be more likely to be sustained, which is a prerequisite for having a positive effect on population health.
Supplementary Material
Acknowledgements
We would like to thank the church leaders who participated in this study and Reverend Dr. Joe Waller and Ms. Martha Navarro who provided church referrals.
Source of Funding
This work was supported by the Charles Drew University/UCLA Cancer Center Partnership to Eliminate Cancer Health Disparities, NIH/NCI# U54 CA143931 & U54 CA143930. CMC was supported by NIH/NCI grant P30CA16042.
Footnotes
Publisher's Disclaimer: This Author Accepted Manuscript is a PDF file of a an unedited peer-reviewed manuscript that has been accepted for publication but has not been copyedited or corrected. The official version of record that is published in the journal is kept up to date and so may therefore differ from this version.
Conflicts of Interest
The authors have no conflicts of interest to report.
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