Congregational health needs by key demographic variables: Findings from a congregational health needs assessment tool

Abstract

Health needs assessments identify important issues to be addressed and assist organizations in prioritizing resources. Using data from the Mid-South Congregational Health Survey, top health needs (physical, mental, social determinants of health) were identified, and differences in needs by key demographic variables (age, sex, race/ethnicity, education) were examined. Church leaders and members (N = 828) from 92 churches reported anxiety/depression (65%), hypertension/stroke (65%), stress (62%), affordable healthcare (60%), and overweight/obesity (58%) as the top health needs in their congregations. Compared to individuals < 55 years old and with a college degree, individuals ≥ 55 years old (OR_range=0.54-0.67) and with ≤ high school degree (OR_range=0.53-0. 63) were less likely to report mental health needs (anxiety/depression; stress). African Americans were more likely to report physical health needs (hypertension/stroke; overweight/obesity) than individuals categorized as Another race/ethnicity (OR_range=2.31-4.27). Individuals with ≤ high school degree were less likely to report affordable healthcare as a need compared to individuals with some college (OR=0.63; 95% CI =0.41-0.99). This research highlights the need for evaluators and planners to design programs that are comprehensive in their approach to addressing the health needs of congregations while also considering demographic variation that may impact program participation and engagement.

1. Introduction

Faith-based organizations (FBOs) have long been the cornerstone of influence in communities, especially in African American communities (Harmon, Strayhorn, Webb, & Hébert, 2018; Mamiya, 2006), and play a significant role in disseminating health-related programs (Bopp & Fallon, 2008; Campbell et al., 2007; Harmon, Schmidt, Escobar, San Diego, & Steele, 2020). Due to their reach and influence, policymakers recently reestablished the Center for Faith-Based and Neighborhood Partnerships within the US Department of Health and Human Services to promote partnerships with FBOs to enhance health promotion initiatives and address community needs (The White House, 2021). Health promotion programs implemented by FBOs have shown success in improving lifestyle behaviors such as physical activity (Arredondo et al., 2017; Gutierrez et al., 2014; Leone et al., 2016; Peterson & Cheng, 2011), healthy eating (Arredondo et al., 2017; Baig et al., 2015; Saunders, Wilcox, Baruth, & Dowda, 2014), and smoking (Schoenberg et al., 2016; Tettey, Duran, Andersen, & Boutin-Foster, 2017) as well as disease outcomes related to diabetes (Gutierrez et al., 2014) and cardiovascular disease (Tettey et al., 2017). However, most health initiatives in FBOs are driven by data or needs identified by outside sources (e.g., researchers, national priorities, healthcare-initiated needs assessments) (Berkley-Patton et al., 2018; Gutierrez et al., 2014) or personal interests within the FBO (Harmon, Chock, Brantley, Wirth, & Hébert, 2015), but not data collected by or specific to the FBO’s membership and community they serve.

Differences in reports of and concerns about health issues often vary by individual factors such as age, race/ethnicity, sex, and educational attainment. For example, older adults are less likely to report mental health concerns such as depression (Haigh, Bogucki, Sigmon, & Blazer, 2018) and are more likely to experience physical health concerns including hypertension and stroke (Lionakis, Mendrinos, Sanidas, Favatas, & Georgopoulou, 2012). When compared to their White counterparts, racial and ethnic minorities are more likely to experience greater mental health-related concerns (e.g., anxiety, depression, stress) due to factors including perceived discrimination, low income, and daily/family stressors (Mezuk et al., 2010; Williams & Mohammed, 2009) and more likely to experience social determinants of health-related disparities (e.g., access to care) (Fiscella, Franks, Gold, & Clancy, 2000). In addition, men experience more life-threatening chronic diseases (e.g., cardiovascular disease) and die younger, whereas women live longer but experience more nonfatal acute and chronic conditions (e.g., rheumatoid arthritis) and disability (Rieker & Bird, 2005). Compared to individuals with higher educational attainment, individuals with lower educational attainment have a greater risk for developing preventable chronic diseases including diabetes and cardiovascular disease (Beckles & Chou, 2016; Kubota, Heiss, MacLe-hose, Roetker, & Folsom, 2017). Therefore, systematically examining health needs and differences in perception of needs by key demographic characteristics may provide insight when developing appropriate health promotion programs with FBOs.

Health needs assessments are a systematic process used to collect and analyze community-level health data (Alfano-Sobsey, Ledford, Decosimo, & Horney, 2014; Li et al., 2009). Assessing community health needs can demonstrate an organization’s contributions to improving community health and lead to accurately identifying outcomes of interest to communities, which contributes to more effective health programs (Alfano-Sobsey et al., 2014; Brown, Holtby, Zahnd, & Abbott, 2005; Evans-Agnew et al., 2018; Peak, Gast, & Ahlstrom, 2010). Health-focused needs assessments also assist organizations in prioritizing resources, thus limiting resource waste (Alfano-Sobsey et al., 2014; Li et al., 2009). Overall, community programs and policies are strengthened when they are based on data from assessments of community health needs (Pennel, McLeroy, Burdine, & Matarrita-Cascante, 2015).

Community health needs assessments are most often conducted by non-profit hospitals, due to mandates in the Patient Protection and Affordable Care Act, or by local public health departments (Kirk, Johnson-Hakim, Anglin, & Connelly, 2017). Reviews of the processes used to conduct these needs assessments, particularly those by non-profit hospitals, have critiqued their use of top-down and deficit-based approaches, limited collaborations both in conducting needs assessments and in implementing strategies to address needs, and a reliance on secondary, population-level data (Beatty, Wilson, Ciecior, & Stringer, 2015; Kirk et al., 2017; Pennel et al., 2015). It is suggested these approaches lead to overemphasis on individual-level health needs and isolated approaches that do not allow for addressing more complex needs and creation of community-level changes (Kirk et al., 2017).

Community-based participatory research (CBPR) is a partnership approach to research that equitably involves community members, practitioners, and academic researchers in all aspects of the process (Israel et al., 2005). CBPR-driven needs assessments use collaborative, cross-sector partnerships to identify perspectives, preferences, and priorities of communities involved (Akintobi et al., 2018). CBPR-driven needs assessments have been shown to contribute to community-engaged health promotion programs as well as policy, systems, and environmental level changes (Akintobi et al., 2018; Kirk et al., 2017).

Only a few, mostly small-scale, studies have successfully implemented CBPR-driven health needs assessments with FBOs (Berkley--Patton et al., 2018; Whitt-Glover, Porter, Yore, Demons, & Goldmon, 2014). These studies have demonstrated health needs assessments are helpful in identifying health-related issues that are most relevant to church leaders and members (Berkley-Patton et al., 2018; Whitt-Glover et al., 2014) and increasing participation to health-promoting behaviors (Whitt-Glover et al., 2014). In addition, the use of assessment tools developed and tailored for congregations based on feedback from community partners and church representatives (Harmon et al., 2020) are likely to elicit more accurate responses and reduce potential bias.

Building upon these initiatives, the Mid-South Congregational Health Survey (MSCHS) and implementation protocol were developed through a CBPR partnership with faith community members, healthcare organizations, and researchers in the greater Memphis, TN area of the Mid-South (i.e., western Tennessee, northern Mississippi) (Harmon et al., 2020). The MSCHS was designed to assess physical, mental, and social/environmental health needs, and the implementation protocol was developed to enable data collection by congregational networks with large numbers of diverse congregations (Harmon et al., 2020). The goal of this paper was to identify the most frequently reported health-related needs and examine differences in these needs by key demographic variables (i.e., age, sex, race/ethnicity, education level). Examining these differences provides insight into how to develop more effective, efficient, and targeted health promotion programs for congregations and the communities they serve.

2. Methods

2.1. Procedure

Data were collected between February 2019 and February 2020 by two faith-based networks (i.e., Methodist Le Bonheur’s Congregational Health Network and Church Health’s Congregational Health Promoter program) that reach nearly 400 congregations in the Mid-South (Church Health Resources, 2020; Cutts et al., 2017). The study design and survey implementation have been described previously (Harmon et al., 2020). In short, participants had to be able to read, write, and comprehend English; at least 18 years old; and attend a congregation within the two faith-based networks. Network staff worked with church leadership to determine the number of surveys to administer per church (1 % of their congregation) and purposive sampling was used to select a diverse set of congregation members plus at least one church leader to complete the survey (Harmon et al., 2020). Surveys were self-administered using a paper-pencil or electronic version (Survey Monkey). Survey completion took approximately 20 – 30 min (Harmon et al., 2020). The [University of Tennessee Health Science Center) Institutional Review Board (IRB) approved all research protocols. The University of Memphis and Appalachian State University IRBs approved the University of Tennessee Health Science Center as the IRB of record.

2.1.1. Measure (MSCHS)

Demographic information included self-reported age (based on average age: <55 years old, ≥55 years old;), sex assigned at birth (men, women), race/ethnicity [African American, Another race/ethnicity (i.e., White, Hispanic/Latino, Asian, Native American, Multiracial, Other)], marital status (married, not married), educational level (≤ high school, some college, ≥ college), and insurance status (yes, no). While interest was on individual-level differences in reported needs, individuals were nested within churches. Therefore, church-related data was also examined, which included church role (leader, member), church size [small (≤100 members), medium (101–350 members), large (351–1000 members), and mega (>1000 members)] (Carroll, 2006), and church zip code (church located above or below the median household income in the greater Memphis, TN area [$51,657]) (United States Census Bureau, 2019). Health-related needs were assessed using a 36-item health index assessing perceived individual (e.g., stress, anxiety/depression, hypertension/stroke), social (e.g., affordable health care, employment, health services), and environmental (e.g., crime/assault/homicide, safe and affordable housing) needs within the congregation and community served by the church (Harmon et al., 2020).

2.2. Data analytic plan

Data were analyzed using SAS Version 9.4. Excluded from analyses were participants with missing data for key demographic variables (i.e., age, sex, race/ethnicity, educational level) and health-related needs. Descriptive statistics were used to summarize data for demographic information and health-related needs. Categorical variables were presented as frequencies and percentages and continuous variables as means and standard deviations.

Generalized linear mixed modeling was performed using PROC GLIMMIX to examine the associations between key demographic variables (age, sex, race/ethnicity, educational level) as predictors and the top five health-related needs from the 36-item health index as outcomes. Needs were limited to the top five given a natural break in the data. All models were adjusted for church size and church zip code. Since participants were nested within churches, variations in needs across churches were examined by inspecting two models for each outcome: Model 1 tested the fixed effects of level-1 variables (i.e., age, sex, race/ethnicity, educational level); Model 2 tested if the inclusion of level-2 variable (i.e., church ID) had a random effect variation on health-related needs across churches. To assess the goodness-of-fit of each model, the Likelihood-Ratio Test (LRT) was performed using the difference between – 2 Log Likelihood (–2LL) of Model 1 and Model 2, with p < 0.05 indicating a significant random effect variation and the need to retain the level-2 variable. Odds ratios (OR) and 95 % confidence intervals (CI) of the best fitting model were inspected to examine the associations between key demographic variables and health-related needs.

3. Results

3.1. Sample characteristics

Table 1 presents the sample characteristics. Data from 828 individuals across 92 congregations were analyzed. Participants were on average 54 years old (SD = 15.4), and more women than men (71% vs. 29%) completed the survey. Most participants were African American (90%). Survey completion was fairly evenly divided between church leaders (51%) and members (48%), although most participants from small- (31%), and medium-sized churches (32%). The five most frequently reported health-related needs across congregations were anxiety/depression (n =540; 65%), hypertension/stroke (n = 538; 65%), stress (n = 514; 62%), affordable healthcare (n = 498; 60%), and overweight/obesity (n = 478; 58%).

Table 1.

Sample Characteristics (N = 828).

Variable		M ± SD or n ( %)
Age		54. 68 ± 15.4
< 55 years old		362 (43.7)
≥ 55 years old		442 (53.4)
Missing		24 (2.9)
Sex n ( %)
Men		230 (27.8)
Women		575 (69.4)
Missing		23 (2.8)
Race/Ethnicity
African American		733 (88.5)
Another Race/ethnicity		77 (9.3)
Missing		18 (2.2)
Educational Level
≤ High school		142 (17.2)
Some college		334 (40.3)
College		332 (40.1)
Missing		20 (2.4)
Marital Status
Yes		367 (44.3)
Missing		21 (2.5)
Insurance Status
Yes		747 (90.2)
Missing		49 (5.9)
Church Role
Member		367 (44.3)
Leader		393 (47.5)
Missing		68 (8.2)
Church Size a	Range of respondents
Small	2–25	256 (30.9)
Medium	3–42	263 (31.8)
Large	5–85	104 (12.6)
Mega	5–82	194 (23.4)
Missing		11 (1.3)
Church Zip Code b
Above median income		295 (36)
Below median income		533 (64)

M (SD) = mean (standard deviation); n (%) = frequency (percentage)

Another race/ethnicity category included White, Hispanic/Latino, Asian, Native American, Multiracial, and other

Some college included some college but no degree and 2-year degree

College included 4-year degree and professional degree (professional, MD, Masters, PhD)

Church member included church member or regular attendee; Church leader included pastor, pastor’s spouse, associate pastor, non-clergy staff, volunteer or ministry lead, and other leadership roles

^aChurch size: small (≤100 members); medium (101 – 350 members); large (351 – 1000 members); mega (> 1000 members)

^bChurch Zip Code Median household income = $51,657

3.2. Variations in the top 5 health-related needs across churches

Top needs slightly varied when examined by church size and church zip code (see Table 2). Large- (n = 60; 58%) and mega-sized churches (n = 131; 68%) as well as churches in low poverty areas (i.e., above the median household income) reported anxiety/depression (n = 198; 67%) as their top need, whereas small-sized churches (n = 185; 72%) and churches in high poverty areas (i.e., below the median household income) reported hypertension/stroke (n = 373; 70%) as their top need; anxiety/depression and hypertension/stroke were tied within medium-sized churches (n = 184; 70%).(Table 3).

Table 2.

Top Needs by Church Characteristics (N = 828).

Church Characteristic	Top Need
	Need 1	n (%)	Need 2	n (%)	Need 3	n (%)	Need 4	n (%)	Need 5	n (%)
Size
Small	Hypertension/ Stroke	185 (72)	Stress	167 (65)	Anxiety/Depression	160 (63)	Healthcare	159 (62)	Youth Programs	156 (61)
Medium	Anxiety/ Depression; Hypertensionc	184 (70)	Diabetes	181 (69)	Stress	172 (65)	Crimes	170 (65)	Overweight/ Obesity; Heart Disease; Healthcarec	168 (64)
Large	Anxiety/ Depression	60 (58)	Healthcare	58 (56)	Hypertension/Stroke	55 (53)	Healthy food	51 (49)	Diabetes; Heart Disease; Stressc	50 (48)
Mega	Anxiety/ Depression	131 (68)	Stress	118 (61)	Healthcare	108 (56)	Hypertension; Healthy foodc	106 (55)	Overweight/Obesity	104 (54)
Zip Code
Above median income	Anxiety/ Depression	198 (67)	Stress	182 (62)	Hypertension/Stroke	165 (56)	Heart Disease	155 (53)	Healthcare	154 (52)
Below median income	Hypertension/ Stroke	373 (70)	Crimes	347 (65)	Healthcare	344 (65)	Youth programs	343 (64)	Anxiety/ Depression	342 (64)

^aChurch size: small (≤100 members); medium (101 – 350 members); large (351 – 1000 members); mega (> 1000 members)

^bChurch zip code median household income in the Greater Memphis, TN area = $51,657

^cNumber of ‘yes’ responses were the same for these needs

Table 3.

Associations between key demographic variables and health-related needs (N = 828).

	Anxiety/Depressiona		Hypertension/Strokeb		Stressa		Affordable Health carea		Overweight/ Obesityb
Variables	OR	95% CI	OR	95% CI	OR	95% CI	OR	95% CI	OR	95% CI
Age
≥ 55 years old vs. < 55 years old	0.54	0.38, 0.75	1.34	0.98, 1.83	0.67	0.48, 0.93	0.96	0.69, 1.34	0.76	0.57, 1.04
Sex
Women vs. Men	1.64	1.16, 2.33	1.40	1.00, 1.97	1.64	1.16, 2.33	1.19	0.85, 1.68	1.67	1.20, 2.31
Race/Ethnicity
African American vs. Another race/ethnicity	1.83	0.99, 3.38	4.27	2.44, 7.45	2.73	1.49, 5.01	1.77	0.96, 3.25	2.31	1.36, 3.94
Educational Level
≤ HS vs. Some College	0.71	0.46, 1.10	0.84	0.54, 1.31	0.64	0.41, 1.00	0.63	0.41, 0.99	0.68	0.45. 1.03
≤ HS vs. College	0.63	0.40, 0.99	0.87	0.56, 1.36	0.53	0.33, 0.83	0.63	0.40, 1.00	0.67	0.44, 1.03
Some College vs. College	0.89	0.62, 1.27	1.04	0.74, 1.46	0.82	0.57, 1.16	1.00	0.71, 1.42	0.99	0.71, 1.38

OR = odds ratio; CI = confidence interval; Bolded values indicate significant associations

Reference category: Age = < 55 years old; Sex = men; Race/ethnicity = Another; Educational Level = some college or college

Another race/ethnicity category included White, Hispanic/Latino, Asian American, Native American, Multiracial, and Other

HS = high school; Some college included some college but no degree or 2-year degree; College included ≥ 4-year degree

All models were adjusted for church size and church zip code

^aModel included fixed effects and random effects (Likelihood-Ratio Test indicated significant random effect variation across churches)

^bModel included fixed effects only (Likelihood-Ratio Test indicated no significant random effect variation across churches)

^cReference category

LRT indicated significant random effect variation in reporting anxiety/depression (LRT = 7.58,p = 0.003), stress (LRT = 12.19,p < 0.001), and affordable healthcare (LRT = 9.17, df = 1, p = 0.001) as needs across churches; the model including fixed and random effects was the best fitting model for these needs. However, there was no significant random effect variation in reporting hypertension/stroke (LRT = 0.00, p > 0.05) and overweight/obesity as needs (LRT = 2.47, p = 0.058) across churches; the model including fixed effects only was the best fitting model for these needs.

3.3. Associations between key demographic variables and health-related needs

There were lower odds of anxiety/depression being noted as a need by individuals ≥ 55 years old (OR=0.54, 95% CI=0.38-0.75) compared to individuals < 55 years old, and by individuals with ≤ high school degree compared to individuals with a college degree (OR=0.63, 95% CI=0.40-0.99), while the odds were higher for women compared to men (OR=1.64, 95% CI=1.16-2.33). The odds of hypertension/stroke being reported as a need was higher among African Americans compared to individuals categorized as Another race/ethnicity (OR=4.27, 95% CI=2.44-7.45). There were lower odds of stress being reported as a need by individuals ≥ 55 years old (OR=0.67, 95% CI=0.48-0.93) compared to individuals < 55 years old, and individuals with ≤ high school degree compared to individuals with a college degree (OR=0.53, 95% CI=0.33-0.83). The odds of reporting stress as a need was higher for women compared to men (OR=1.64, 95% CI=1.16-2.33) and African Americans compared to individuals categorized as Another race/ethnicity (OR=2.73, 95% CI=1.49-5.01). There were lower odds of affordable healthcare being reported as a need by individuals with ≤ high school degree compared to individuals with some college (OR=0.63, 95% CI=0.41-0.99). The odds of overweight/obesity being reported as a need were higher for women compared to men (OR=1.67, 95% CI=1.20-2.31) and African Americans compared to individuals categorized as Another race/ethnicity (OR=2.31, 95% CI=1.36-3.94).

4. Discussion

Using a CBPR-driven congregational health needs assessment, this study found the most frequently reported needs included mental health (i.e., anxiety/depression, stress), physical health (i.e., hypertension/stroke, overweight/obesity), and social determinants of health (i.e., affordable healthcare). When differences in needs by key demographic variables were examined, participants who reported mental health-related needs less often were 55 years old or older and had a high school degree or less, while participants who reported physical health-related needs more often identified as African American. Needs related to social determinants of health were also reported less often by individuals with a high school degree or less. Findings provide insight into health-related needs and demographic considerations needed when developing programs and policies using faith-based collaborations.

4.1. Top health needs

In this sample of predominantly African-American church attendees, needs related to mental (i.e., anxiety/depression, stress) and physical (i. e., hypertension/stroke, overweight/obesity) health were among the most frequently reported needs, with anxiety/depression as the highest ranked health concern. While variation existed in top needs by church size and location, needs identified in other studies of predominantly African-American churches have primarily been physical health-related (Berkley-Patton et al., 2018; Whitt-Glover et al., 2014), with only one study identifying depression as a top priority (Berkley-Patton et al., 2018). Compared to Whites, African Americans are disproportionately affected by mental health conditions (e.g., depression, anxiety, stress) due to factors including perceived discrimination, racial injustice, police harassment, low income, and daily/family stressors (Alang, McAlpine, McCreedy, & Hardeman, 2017; Kasper et al., 2008; Mezuk et al., 2010; Williams & Mohammed, 2009). Research suggests African Americans are less likely to seek professional support, but often turn to churches and spiritual leaders to meet their mental health needs (R. D. Campbell & Winchester, 2020). Historically, mental health concerns were rarely examined or addressed in African-American churches (Hankerson & Weissman, 2012), although recently efforts to address mental health needs have grown (Berkley-Patton et al., 2021; Hankerson et al., 2015, 2018). Evaluating potential barriers (e.g., stigma; access to culturally tailored services; lack of providers with similar lived experiences; logistical barriers such as transportation, cost, and childcare) may help improve strategies to address mental health concerns in congregations, particularly among African-American faith communities.

Affordable healthcare also was identified as one of the top five health needs in this study. In previous congregational health needs assessments (Berkley-Patton et al., 2018; Whitt-Glover et al., 2014), needs related to social determinants of health were less often assessed or identified as a top health concern. However, recent local community health needs assessments have reported access to care as well as other social determinants of health (e.g., education, neighborhood and built environment, economic stability) as important health issues in the Mid-South (Baptist Memorial Health Care, 2019; Methodist Le Bonheur Healthcare, 2019). When top needs were examined by church size in this study, more top needs related to social determinants of health (i.e., affordable healthcare, youth programs, crimes) were reported by small-and medium-sized churches than larger churches. Previous research suggests unlike larger churches, smaller churches are more likely to report concerns related to social determinants of health, but are less likely to offer programs that could help address these issues due to limited resources (Powell, 2021). Given more than half of participants in this study attend a small- to medium-sized church, forming partnerships with larger churches may increase their access to resources that could help address needs related to social determinants of health (Powell, 2021).

4.2. Differences in health needs by key demographic variables

Anxiety/depression and stress were reported as needs more often by women than men in this study, which aligns with previous studies (American Psychological Association, 2012; Terlizzi & Villaroel, 2020; Villaroel & Terlizzi, 2020). Stress, but not anxiety/depression, was reported as a need more often by individuals who identified as African American compared to Another race/ethnicity. Previous studies suggest individuals in racial/ethnic minority groups experience greater long-term exposure to discrimination, poverty, and other socioeconomic stressors compared to White individuals, which has important implications for one’s mental health (Williams, 2018). In addition, a previous study found African-American women often experience chronic stress and health disadvantages due to the interaction of race, class, and age (Lekan, 2009).

In this study, individuals 55 years old and older were less likely to report both anxiety/depression and stress as needs compared to individuals under 55 years of age while individuals with a high school education or less were less likely to report these needs compared to individuals with a college education. While findings related to age are in line with national data (Haigh et al., 2018), given the research cited above and the study’s sample being primarily African-American women, they were unexpected in this study. The findings related to education were also unexpected given the connection between socioeconomic status (as measured by educational attainment) and mental health has been well documented (Murali & Oyebode, 2004). The long-term exposure of African-American women to stress needs to be taken into consideration by health promotion researchers and practitioners. In addition, more research is needed to examine how churches and faith communities may help buffer the impact of racial, socioeconomic, and other adversities on mental health.

In this study, the physical health needs hypertension/stroke and overweight/obesity were reported more often by African Americans than individuals categorized as Another race/ethnicity. This finding is consistent with research documenting high rates of these physical health conditions among African Americans (Fryar, Ostchega, Hales, Zhang, & Kruszon-Moran, 2017; Hales, Carroll, Fryar, & Ogden, 2020). Similarly, overweight/obesity were reported more often by women than men. A review found most church-based health promotion programs have focused on African-American churches and found success (Campbell et al., 2007), with several studies including lifestyle interventions (e.g., weight loss, healthy eating, physical activity) aimed to prevent or manage overweight/obesity and high blood pressure (Resnicow et al., 2004; Yanek, Becker, Moy, Gittelsohn, & Koffman, 2001; Young & Stewart, 2006). Despite improvements in health promotion efforts, it is possible that the persisting high prevalence of high blood pressure (Ostchega, Fryar, Nwankwo, & Nguyen, 2020) and overweight/obesity (Lofton, Ard, Hunt, & Knight, 2023) among African Americans are contributing to their perception that these physical health needs are significant health issues in their community.

When differences in needs related to social determinants of health were examined, affordable healthcare was reported as a need less often by individuals with a high school education or less compared to individuals with some college. The point estimate and confidence interval were similar to the non-significant association between individuals with a high school education or less and individuals with a college education. The implementation of the Affordable Care Act (U.S. Government Publishing Office, 2010) reduced rates of uninsured individuals (Chen, Vargas-Bustamante, Mortensen, & Ortega, 2016), and other improvements in access to care among younger adults and across incomes have been observed (Shartzer, Long, & Anderson, 2016). Despite this progress, large gaps in access and affordability continue to persist, particularly among low-income adults (Shartzer et al., 2016). It has been suggested that higher educational attainment leads to better employment opportunities, which increase one’s socioeconomic capacity (e.g., income) and facilitates access to healthcare (Hahn & Truman, 2015). Poverty rates in the Mid-South have remained consistently high (Delavega & Blumenthal, 2020) and lower educational attainment continues to be prevalent, with fewer than one-third of adults over the age of 25 having completed a 4-year degree (Methodist Le Bonheur Healthcare, 2019). As part of addressing health comprehensively, faith-based programs should include strategies to assist individuals in accessing education (e.g., college enrollment assistance, financial aid, and scholarship support), which could increase socioeconomic capacity and insure access to healthcare in the future.

5. Limitations and strengths

Study data were obtained from churches in the Mid-South and from a sample with a large proportion of African-American women. However, the current sample is proportional to the racial/ethnic and sex breakdown of congregation attendees in the US (Pew Research Center, 2014, 2021); thus, findings are representative of congregations in the broader population. However, there were a small number of respondents in the other race/ethnicity groups, which led to the creation of an “Another race/ethnicity” category, making it difficult to interpret the differences in needs among participants in these groups. In addition, study data were collected before the COVID-19 pandemic, which may have increased both mental health and chronic disease-related needs.

This study identified perceived health needs of both congregation leaders and members instead of needs identified by outside sources (e.g., researchers, healthcare organizations), which generates new knowledge and enables the development of effective, efficient, and targeted health promotion programs by congregations and the community (Issel & Wells, 2018). As noted earlier, needs assessments that use top-down, deficit-based approaches, lack collaborations, and rely on secondary, population-level data often underestimate structural and environmental factors influencing health (Kirk et al., 2017). Our cross-sector partnerships and CBPR approach to developing a needs assessment tool and data collection processes enhanced our ability to identify individual-level needs (i.e., physical- and mental-health related) and social determinants of health. Long-standing partnerships with FBOs, which included navigators and staff with extensive experience and history working with congregation leaders and members, contributed to successful recruitment of churches and participants, implementation of the MSCHS, and positions us to work with FBOs on solutions. In addition, training navigators and staff in the recruitment and data collection processes helped build research capacity, which is congruent with core CBPR principles (Israel, Schulz, Parker, & Becker, 1998).

6. Lessons learned

In this study, the top needs related to mental health (anxiety/depression, stress), physical health (hypertension/stroke, overweight/obesity), and social determinants of health (affordable healthcare) were identified among predominantly African-American church attendees. Data collected from health needs assessments can identify top health priorities in congregations and communities (Berkley-Patton et al., 2018; Whitt-Glover et al., 2014), but next steps should enhance existing health promotion programs or develop new programs and policies to address identified needs. When enhancing or developing programs, FBOs should look at ways to partner with each other to maximize the use of resources. FBOs also will need to understand the needs of sub-groups of their congregation to ensure strong program participation and engagement. Lastly, the top needs related to mental, physical, and social determinants of health identified in this study have overlapping root causes and behavioral risk factors (Braveman & Gottlieb, 2014). While faith-based health promotion programs have a history of addressing physical health (Campbell et al., 2007), taking a more comprehensive approach that addresses mental and physical health as well as socioeconomic capacity is needed. Evaluators and program planners can take an active role in incorporating these lessons into faith-based health promotion research and practice.

Biographies

Brook E. Harmon, PhD, RD, FAND is an Associate Professor in the Department of Nutrition and Health Care Management at Appalachian State University in Boone, NC, USA. Dr. Harmon uses the application of community-based participatory research practices to examine the role of the faith-based community in the development and implementation of health promotion and disease prevention programs. Much of her work includes partnering with churches to promote health through culinary and physical activity skills training as well as research on leadership and environmental factors that influence healthy behaviors.

Emily Rose N. San Diego, PhD is a Postdoctoral Fellow at Scripps Whittier Diabetes Institute of Scripps Health in San Diego, CA, USA. Her research focuses on using community-based participatory research approaches to develop and modify diabetes self-management education and support programs for underrepresented communities, including racial/ethnic minority populations.

Latrice C. Pichon, PhD, MPH, CHES is an Associate Professor in the Division of Social and Behavioral Sciences, School of Public Health at The University of Memphis in Memphis, Tennessee, USA. Her research focuses on exploring the role of the faith-based community in addressing HIV awareness and prevention, partnering with community-based organizations to understand HIV outreach, care, and utilization needs among vulnerable populations, and using the application of community-based participatory research approaches.

Terrinieka W. Powell, PhD is an Associate Professor and Vice Chair of Inclusion, Diversity, Anti-Racism and Equity (IDARE) in the Department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health in Baltimore, MD, USA. Dr. Powell collaborates with institutions to promote adolescent well-being prevent teen pregnancy, HIV, and substance use among adolescents of color.

Fedoria Rugless, PhD is a Research Assistant Professor in the College of Health Sciences at the University of Memphis and the Director of Research at Church Health in Memphis, TN, USA. Dr. Rugless works as a liaison between University of Memphis researchers and Church Health, with the goal of building a strong collaborative research network that enhances the community-based clinical work at Church Health while providing University faculty with the opportunity to conduct research within a model healthcare organization.

Nathan T. West, MS is a Doctoral Candidate in the Division of Social and Behavioral Sciences, School of Public Health at The University of Memphis in Memphis, Tennessee, USA. His research interest focus is on physical activity promotion and obesity/chronic disease prevention. He is also interested in examining and addressing the health disparities that exist among clergy.

Lottie E. Minor, MEd is the Project Director at Oak Hill Regional Community Development Corporation at Hernando, MS, USA, a faith-based, non-profit organization dedicated to bringing residents and stakeholders together, serve as a community resource, and promote a progression of the residents of the Mid-South Region.

Sterling McNeal, BS is a Faith Community Relations Coordinator at Church Health in Memphis, Tennessee, USA. Mr. McNeal consults with faith communities to develop holistic health ministries in the greater Memphis, TN area.

Lauren McCann, MSW, CCLS is the Director of Operations for the pediatric primary care practices at Le Bonheur Children’s Hospital in Memphis, TN, USA. She is responsible for overall planning, organization, implementation, control activities and operations of six pediatric primary care sites in the greater Memphis, TN area.

Lauren S. Hales is a Doctoral Student in Counseling Psychology at the University of Southern Mississippi in Hattiesburg, Mississippi, USA. Before returning to school, she worked at Church Health where she worked with faith communities to develop holistic health ministries in the greater Memphis, TN area.

Rachel Davis, BA is the Director of Communications at First Presbyterian Church of Nashville, Nashville, TN, USA. While working at Church Health and in her current position, she works to promote connections between faith-based organizations and the communities they serve.

Jonathan C. Lewis, DMin, BCC is the Director of Community Partnerships at Methodist Le Bonheur Healthcare in Memphis, TN, USA. He is an ordained Deacon in the United Methodist Church and a Board-Certified Chaplain. Dr. Lewis also directs the Mission Integration Division and Faith Health Collaborative at Methodist Le Bonheur Healthcare.