Churches as Influential Institutions for Health Promotion
There are several studies citing churches as influential institutions for health promotion in black communities.1,2,3 It has also been established that therapeutic lifestyle change is a recommended treatment for hypertension. A recent study reported in Circulation compared the effectiveness of TLC plus motivational interviewing versus health education alone.4 The FAITH study (Faith-Based Approaches in the Treatment of Hypertension) is the first community-based program to implement a lifestyle intervention for systolic blood pressure reduction delivered by lay health advisors in churches.4
The FAITH trial differs from similar studies in that it included a control group and rigorous assessment of blood pressure outcomes. It was a two-arm randomized controlled trial that tested the hypothesis that participants in the churches randomized to the motivational interviewing-therapeutic lifestyle change group would have greater mean arterial pressure, systolic blood pressure, and diastolic blood pressure reduction at six months and greater blood pressure control at nine months than those in churches randomized to the health education group. The trial was conducted in 32 black churches in New York City. Participants were identified at the churches through responses to presentations, posting of flyers, face to face recruitment, and endorsement from the pastors from the pulpit.
The motivational interviewing-therapeutic lifestyle change group consisted of 11 90-minute weekly group sessions focused on healthy lifestyle behaviors such as low fat and low sodium diet rich in vegetables and fruits, weight loss, and increasing physical activity. The group was given information on meal planning, stress management, medication adherence, goal setting, and tasting healthy foods. They were encouraged to keep food and exercise diaries. All instruction included elements of prayer, scripture, and faith-based discussion. The group sessions were followed by three individual motivational interviewing sessions to help participants with problem-solving and maintaining lifestyle changes. Lay health advisors were recruited at the churches and trained to deliver the intervention.
The health education group served as the control group and received one lifestyle session on blood pressure management plus ten informational sessions led by health experts on health education topics. The information sessions focused on lifestyle behaviors and hypertensive drug management. Participants also received the National Institute of Health booklet “Your Guide to Lowering Blood Pressure.” The health experts presented on additional topics such as fire safety, substance abuse, Alzheimer disease, and environmental health.
Although improvement was observed in both arms, the study demonstrated that a comprehensive faith-based lifestyle intervention plus motivational interviewing, led by lay heart advisors in churches, was associated with significantly greater reduction in systolic blood pressure when compared with health education among blacks with uncontrolled hypertension. Average systolic blood pressure reduction at six months was -16.53 mm Hg in the motivational interviewing-therapeutic lifestyle change group and -10.74 mm Hg in the health education group. At nine months, the motivational interviewing-therapeutic lifestyle change group showed -18.2 mm Hg reduction in systolic blood pressure and the health education group -13.0mm Hg.
This study is also important from a policy perspective as it focuses on the use of community health workers and lay health advisors as an effective means for implementing evidence-based public health practices in community settings. The low cost and the potential for sustainability are two positive features of this model.5 According to the Centers for Disease Control, this model is associated with effective communication of health messages in “culturally salient ways.”6
- National High Blood Pressure Education Program. Churches as an Avenue to High Blood Pressure Control. Bethesda, MD: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, National High Blood Pressure Education Program; 1987.
- Wimberly AES. The role of black faith communities in fostering health. In: Taylor SE, Braithwaite RL, eds. Health Issues in the Black Community. 2nd ed. San Francisco, CA: Jossey-Bass; 2001:129–150.
- Peterson J, Atwood JR, Yates B. Key elements for church-based health promotion programs: outcome-based literature review. Public HealthNurs. 2002;19:401–411.
- Circ Cardiovasc Qual Outcomes. 2018;11:e004691. DOI: 10.1161/CIRCOUTCOMES.118.004691
- Institute of Medicine (US) Committee on Public Health Priorities to Reduce and Control Hypertension. A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension. Washington, DC:National Academies Press (US); 2010.
- Centers for Disease Control and Prevention (CDC). CDC’s Division of Diabetes Translation Community Health Workers/Promotores de Salud: Critical Connections in Communities. tps://www.cdc.gov/diabetes/projects/pdfs/comm.pdf.