COVID-19 Testing in African American Churches Using a Faith–Health– Academic Partnership

Abstract

Increasing access to COVID-19 testing in influential, accessible community settings is needed to address COVID-19 disparities among African Americans. We describe COVID-19 testing intervention approaches conducted in Kansas City, Missouri, African American churches via a faith–health–academic partnership. Trained faith leaders promoted COVID-19 testing with church and community members by implementing multilevel interventions using a tailored toolkit and standard education information. The local health department conducted more than 300 COVID-19 tests during or after Sunday church services and outreach ministry activities. (Am J Public Health. 2022;112(S9):S887–S891. https://doi.org/10.2105/AJPH.2022.306981)

During the COVID-19 pandemic, African Americans have experienced disproportionate rates of COVID-19 cases, hospitalizations, and deaths compared to White individuals.^1–3 These disparities have been exacerbated by multilevel social determinants, including reduced access to community resources and COVID-19 information from trusted sources.⁴ With a long history of influence and extensive reach with African American populations,⁵ the Black Church may serve as a highly accessible setting in which to provide trusted COVID-19 information, testing, and linkage to care services.

INTERVENTION AND IMPLEMENTATION

A tailored intervention called A Faithful Response to COVID-19 (Faithful Response) is a Rapid Acceleration of Diagnostics-Underserved Populations faith community engagement project aimed at increasing access to COVID-19 testing among African American church populations. Using a community-based participatory research approach, African American faith leaders and local health department staff were engaged in the conceptualization, design, implementation, and evaluation of the project to ensure appropriate cultural and religious tailoring for the church context.⁶ They also provided information on alternate strategies for intervention delivery, as shown in Table 1, to mitigate pandemic-related changes in public health practices and restrictions (e.g., social distancing, limits on size of gatherings, shutdowns) by engaging congregants through multiple church communication outlets. Additionally, trained church health workers coordinated intervention delivery during existing, multilevel church activities using a culturally and religiously tailored COVID-19 testing toolkit.

TABLE 1—

Alternative Modes of Church Activities and Communications During the COVID-19 Pandemic to Reach Congregants and Community Members With Faithful Response Intervention Components: Kansas City, MO, August 2021–January 2022

Mode	Alternative Modes	Mode Description	Adaptation for Study Delivery
Sunday/midweek church worship services and outreach ministry activities
In-person	Outdoor services and events	Services were held in church parking lots with members remaining in cars. Services were held in tents with social distancing. Drive-through prayer events with prayers and blessings were delivered through car windows. Parking lot entertainment events were held (e.g., movies shown on jumbo screens, gospel concerts, summer fests) with limited capacity. Fairs (e.g., back-to-school, health fairs) were held with limited capacity. Drive-through social service events were held (e.g., food pop-ups, masks and hand sanitizer distribution).	Faithful Response toolkit materials and activities were available in print and electronic format for implementation during in-person delivery. Faithful Response toolkit materials were handed out through car windows or on resource tables. To model COVID-19 testing, pastors were tested from the pulpit during church services. COVID-19 testing was conducted in cars in parking lots and fellowship halls with social distancing during/after Sunday church services and outreach ministry events. Lists of persons attending church services and outreach events during project implementation were maintained, especially during COVID-19 surges. Electronic tablets and QR codes were used during onsite COVID-19 testing to assist the registration process. Electronic tablets and pens were sanitized after each use. Medical students assisted with completion of onsite COVID-19 registration and testing. Contact tracers were introduced onsite during COVID-19 testing events and distributed booklets with their bios, and COVID-19 testing and contact- tracing information.
	Indoor services	To limit sanctuary capacity, Sunday service admittance was assigned by alternating first letter of last names. To support contact tracing, registries of members attending church services were maintained as required by local COVID-19 orders. To enhance social distancing, only one family per pew or every other pew was allowed. To limit contact with ushers, QR (quick response) codes with church order of services and announcements were shown on church video screens.
	Small groups	To limit number of persons congregating and ease ability to social distance, sermon messages and Bible study were delivered in small group settings.
Technology-based (non–in-person) church communication outlets
Internet-based communications	Zoom and live streaming	Zoom and live streaming were used to deliver Sunday and midweek worship services.	Faithful Response toolkit materials were available for delivery using electronic format. Web site and social media platforms were used to increase awareness about COVID-19 and promote testing events. E-mail, telephone, and text messages were used to communicate church COVID-19 policy and education, prevention, and testing information, and promote testing events. An automated text-messaging platform was used to deliver one to two text messages per day on COVID-19 information, health-related behaviors (e.g., physical activity, prayers and meditation, connecting with others), and testing. Word of mouth was used by church health workers to promote COVID-19 awareness and testing.
	Web site	Church Web sites were used to post recorded worship and other church services.
	Social media	Facebook, Twitter, and Instagram were used to post sermons and messages and distribute church announcements.
	E-mail	E-mail was used to share information about special church events and church COVID-19 policies.
Telephone and text messages	Telephone and text-messaging systems	Telephone and texts were used as communication outlets, especially for members not using social media.
	Each one reach one	Members were encouraged to call and check in on one to two members weekly. Automated text/e-mail systems were used to contact church members and community members using church outreach ministries.

Participating churches were matched on size and randomly assigned to intervention (Faithful Response) or comparison conditions (standard COVID-19 education information). Church health workers delivered the four-month Faithful Response intervention during existing, multilevel church activities using a culturally and religiously tailored COVID-19 toolkit that included digital tools and consisted of (1) individual self-help materials, (2) COVID-19 educational materials delivered in ministry groups, (3) virtual or in-person church services with COVID-19–related materials and activities (e.g., sermons, pastors modeling receipt of COVID-19 testing, testimonials, church bulletins), and (4) church- and community-level automated tailored text messages and COVID-19 testing events. At the church and community levels, contact tracers from the Kansas City Missouri Health Department (KCMOHD) participated in the church-based COVID-19 testing events to assist with registering persons seeking testing, introduce themselves to build rapport with persons getting tested, and provide tailored information on COVID-19 testing, receipt of test results, and the contact-tracing process. Trained church health workers in comparison churches distributed nontailored, standard COVID-19 educational brochures and made general announcements about the availability of testing during church services.

All intervention and comparison churches hosted two COVID-19 testing events—one during or after Sunday church services and one during their outreach ministry activities. Church-based testing took place in church parking lots as drive-through events and in church fellowship halls. Persons seeking COVID-19 testing could preregister online, drive up, or walk in and register to receive their test. The KCMOHD conducted nasal anterior PCR (polymerase chain reaction) tests onsite at participating churches with assistance from university medical students. Test results were typically returned within 24 hours. Persons who tested positive for COVID-19 received contact-tracing and referral services for health-related or community resource needs.

PLACE, TIME, AND PERSONS

Eight churches that primarily serve African Americans in urban Kansas City, Missouri, in socially vulnerable zip codes participated in the intervention project between August 2021 and January 2022.

The African American church population participating in the project included adult church members and community members using church outreach ministries (e.g., food and clothing pantries, social services) coordinated by the participating churches. Free COVID-19 testing services were available to persons enrolled in the Faithful Response study and to nonstudy persons seeking testing. Individuals did not need to have COVID-19 symptoms or known previous exposure to receive testing.

PURPOSE

Increasing access to COVID-19 testing in influential, accessible community settings is needed to address COVID-19 disparities among African Americans. Past African American church–based studies have demonstrated that multilevel health promotion interventions that use religiously tailored toolkits are feasible, acceptable, and effective when delivered by trained church members.^7,8 African American churches have many characteristic strengths that could be tapped into to promote and offer COVID-19 testing, including high church attendance, infrastructure (e.g., fellowship halls, telephone messaging systems, in-person and virtual formats, volunteers), highly active health ministries, and highly influential pastors.^5,9,10 They also have contact with underserved community members, who may be at great risk for COVID-19, through outreach ministry services. Additionally, studies have reported the influence of African American pastors on the health behaviors of their members.¹¹ These and other strengths of African American churches may uniquely position them to increase reach and access to COVID-19 testing with church members and community members using outreach services. We describe collaborative faith–health–academic approaches for enhancing access to COVID-19 testing along with testing outcomes in African American churches.

EVALUATION AND ADVERSE EFFECTS

Before the launch of the intervention phase, meetings were conducted with the participating churches’ senior pastor and assigned church health workers to understand church characteristics (e.g., membership size, health ministry activities). The churches ranged in membership size from 75 to 400, with a mean size of 200 members (Table 2). All had functioning outreach ministries. Social vulnerability was measured using the Centers for Disease Control and Prevention Social Vulnerability Index.¹² Church addresses were geocoded and linked to Centers for Disease Control and Prevention data by census tract. Churches were exclusively in high-vulnerability areas with Social Vulnerability Index scores ranging from 0.66 to 0.99.

TABLE 2—

Characteristics of Participating Churches and Persons Who Received a COVID-19 Test at a Participating Church: Kansas City, MO, August 2021–January 2022

Characteristic	Overall	Intervention Churches	Comparison Churches
Churches, no.	8	4	4
Denomination, no. (%)
Baptist	2 (25.0)	0	2 (50.0)
Church of God in Christ	1 (12.5)	0	1 (25.0)
Methodist	2 (25.0)	2 (50.0)	0
Nondenominational	2 (25.0)	1 (25.0)	1 (25.0)
Pentecostal	1 (12.5)	1 (25.0)	0
Membership size, mean ±SD	200 ±114	201 ±98	199 ±133
Social Vulnerability Index, mean	86.7	86.8	86.5
Persons tested for COVID-19, no.	308	180	128
Race, no. (%)
African American/Black	280 (90.9)	164 (91.1)	116 (90.6)
White	15 (4.9)	11 (6.1)	4 (3.1)
Other	13 (4.2)	5 (2.8)	8 (6.3)
Age, y, no. (%)
≤ 19	18 (5.8)	8 (4.4)	10 (7.9)
20–29	24 (7.8)	16 (8.9)	8 (6.3)
30–49	84 (27.4)	44 (24.4)	40 (31.5)
50–69	137 (44.6)	76 (42.2)	61 (48.0)
≥ 70	44 (14.3)	36 (20.0)	8 (6.3)
Sex at birth, no. (%)
Female	213 (69.2)	119 (66.1)	94 (73.4)
Male	95 (30.8)	61 (33.9)	34 (26.6)
Kansas City, MO resident, no. (%)	229 (74.4)	135 (75.0)	94 (73.4)
COVID-19 positive, no. (%)	6 (2.0)	3 (1.7)	3 (2.3)

Using an online registration and tracking system, the KCMOHD collected demographic and zip code data on all persons who received a COVID-19 test. These de-identified data were analyzed via a data-sharing agreement between the university and the KCMOHD.

Overall, 308 persons were tested for COVID-19 (mean age = 51.6; SD = 17.8); six tested positive. Most of those tested were African Americans, females, and aged 50 years and older (Table 2). Most were Kansas City residents, and a large majority lived in socially vulnerable zip codes within the city. Persons tested were more likely to be older in the intervention churches than in the comparison churches. More persons were tested in the intervention churches than in the comparison churches.

We are not aware of any adverse effects associated with this project. Those who tested positive for or believed that they had been exposed to COVID-19 received immediate contact-tracing services, which included guidance on isolation and quarantine practices to mitigate COVID-19 transmission. They also received linkage to care services, which included referrals to community resources.

Limitations of this study are related to the limited number of religions and urban Kansas City churches represented. Therefore, findings may not be generalizable.

SUSTAINABILITY

Church-based health promotion interventions that have been designed to be embedded in the natural functioning of the church context have been shown to increase uptake of congregants’ health behaviors, especially when delivered by trained church leaders using supportive, religiously tailored tools.^7,8 Similarly, the Faithful Response project has great promise for adaptability of its religiously and culturally tailored materials and procedures in African American churches that have existing infrastructure (e.g., committed pastors, meeting spaces, multiple communication outlets with church and community members) for multilevel intervention delivery.

PUBLIC HEALTH SIGNIFICANCE

The Faithful Response intervention approach has the potential to provide a multilevel model for delivering scalable, wide-reaching COVID-19 testing as well as linkage to care services by supporting African American faith leaders with culturally appropriate, easy-to-use tools and health agency partnerships.