Faith, Activity, and Nutrition Program

Chronic diseases, particularly hypertension, are major causes of health complications and death in the communities of people of African descent. In response to this challenge, the Faith, Activity, and Nutrition (FAN) program, a “5-year PA [physical activity] and nutrition intervention implemented in African Methodist Episcopal (AME) churches”, aimed to evidence-base the utility of churches with variable individual beliefs and behavior, congregants, and pastors in a social-ecological model for encouraging lifestyle changes among individuals of African descent [1].

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This community-based participatory research program involved a double-blind research study, where congregants from 38 churches in the intervention group participated in the physical activity and diet change programs, whereas the members from 36 other churches in the control or non-intervention group did not participate in these lifestyle change activities. The goal was to evaluate if there would be any changes in health outcomes resulting from the interventions compared to not adopting any of the lifestyle change modifications.  

Preliminarily, the church members assessed their health education and promotion intervention needs. Subsequently, in every church, the pastor, health director/FAN coordinator, and cook/ lead kitchen staff received training to learn about the FAN program, connect “study goals to scripture and to the AME church’s health mission”, and come up with practical ways to implement physical and healthy eating activities in their churches [1]. Each church appointed two members to attend workshops about the “redesign of favorite recipes to be healthier”, and the “development of flavor in foods through healthy ingredients” based on the Dietary Approaches to stop Hypertension (DASH) meal plan [1].

The implementation phase of this research study was made possible with the allocation of a stipend “up to $1000 depending on church size” [1]. During a period of 15-months, the pastors and cooks received social cognitive theory-based materials that empowered them to motivate the physical activity and dietary changes among the church members. These materials included bulletin inserts, culturally-relevant recipes, a pedometer for the pastor to use for demonstrative purposes; and church fans, cups and aprons promoting healthy eating and physical activity levels.

Besides the sociodemographic data, the researchers collected and analyzed the church members information on the amount of self-reported physical activity for one week during the past 4 months, their self-reported intake of cups of fruits and vegetables over the past month using the National Cancer Institute (NCI) fruit and vegetable all-day screener, and their measured blood pressure post 5 minutes of reset “three times on the right arm” using the automated DinaMap ProCare (DPC-100 X-EN). They also used the Fat and Fiber-Related behavior Questionnaire to evaluate the self-reported intake of fat and fiber over the past 3 months, and assessed the levels of physical activity (sedentary, moderate and vigorous) of the church members who walked with an actigraph accelerometer “for a minimum of 3 days and for at least 10 hours per day” over a period of “5 to 7 consecutive days”.

The majority of the church members (99.6%) were African-Americans, 76.4% were males, 89.2% had a high school diploma or more, 61.9% were obese, and 27.1% were overweight, 92% identified themselves as smokers, and 64.7% were living with high blood pressure.
 
The results of this unique study were very much encouraging. Besides the 1 church that was lost to follow-up in the intervention group and 3 similar cases in the control group, the study report was based on the data of more than 383 church members in the intervention group and more than 261 members in the control group. The church members who belonged to the intervention group increased in their amount of moderate to vigorous-intensity physical activity (on average 3.84 to 4.14). There was a modest increase in the level of fruits and vegetables consumption. No significant changes were observed in the blood pressure measurements or in the level of fat and fiber consumption among the church members. Male church members were more likely to engage in moderate to vigorous-intensity physical activity when exposed to the verbal messages by the pastors and the written messages on the available materials in the church [2].

This study suggested that to reduce the disparities in chronic disease in the communities of people of African descent, which might include the Haitians, environmental church support offers a unique advantage, especially when 53% of blacks attend “religious services one or more times a week” [3]. Environmental support in the church may greatly help initiate and sustain an active lifestyle in congregants based on their behavioral capacity. Health educators could benefit from adapting their health promotion interventions to the preferred channels of communication (e.g. spoken and verbal informational church support), behavioral skills and spirituality (i.e. church setting with a male preacher) of congregants who participate in church activities whether actively or passively. These methodologies in health promotion practice would not only be cost-effective for the program planner, but also for the beneficiaries, including the pastor. 
 

References 

1. Wilcox, S., Parrott, A., Baruth, M., Laken, M., Condrasky, M., Saunders, R., … Zimmerman, L. (2013). The faith, activity, and nutrition program: A randomized controlled trial in African-American churches. American Journal of Preventive Medicine, 44(2), 122-131. doi: 10.1016/j.amepre.2012.09.062            

2. Harmon, B. E., Blake, C. E., Thrasher, J. F., & Hébert, J. R. (2014). An evaluation of diet and physical activity messaging in African American churches. Health Education & Behavior, 41(2), 216-224.  doi: 10.1177/1090198113507449

3. Baruth, M., Wilcox, S., Saunders, R. P., Hooker, S. P., Hussey, J. R., & Blair, S. N. (2013). Perceived environmental church support and physical activity among black church members. Health Education & Behavior, 40(6), 712-720. doi: 10.1177/1090198113477110