Cheryl L. Holt

Culturally appropriate storytelling to improve blood pressure: a randomized trial

BACKGROUND Storytelling is emerging as a powerful tool for health promotion in vulnerable populations. However, these interventions remain largely untested in rigorous studies. OBJECTIVE To test an interactive storytelling intervention involving DVDs. DESIGN Randomized, controlled trial in which comparison patients received an attention control DVD. Separate random assignments were performed for patients with controlled or uncontrolled hypertension. (ClinicalTrials.gov registration number: NCT00875225) SETTING An inner-city safety-net clinic in the southern United States. PATIENTS 230 African Americans with hypertension. INTERVENTION 3 DVDs that contained patient stories. Storytellers were drawn from the patient population. MEASUREMENTS The outcomes were differential change in blood pressure for patients in the intervention versus the comparison group at baseline, 3 months, and 6 to 9 months. RESULTS 299 African American patients were randomly assigned between December 2007 and May 2008 and 76.9% were retained throughout the study. Most patients (71.4%) were women, and the mean age was 53.7 years. Baseline mean systolic and diastolic pressures were similar in both groups. Among patients with baseline uncontrolled hypertension, reduction favored the intervention group at 3 months for both systolic (11.21 mm Hg [95% CI, 2.51 to 19.9 mm Hg]; P = 0.012) and diastolic (6.43 mm Hg [CI, 1.49 to 11.45 mm Hg]; P = 0.012) blood pressures. Patients with baseline controlled hypertension did not significantly differ over time between study groups. Blood pressure subsequently increased for both groups, but between-group differences remained relatively constant. LIMITATION This was a single-site study with 23% loss to follow-up and only 6 months of follow-up. CONCLUSION The storytelling intervention produced substantial and significant improvements in blood pressure for patients with baseline uncontrolled hypertension. PRIMARY FUNDING SOURCE Finding Answers: Disparities Research for Change, a national program of the Robert Wood Johnson Foundation.

Development and validation of brief scales to measure collectivism, religiosity, racial pride, and time orientation in urban African American women.

This article describes the development and pilot-testing of brief scales to measure four cultural constructs prevalent in urban African American women. Internal consistency and temporal stability were assessed in two convenience samples (n = 47 and n = 25) of primarily lower-income African American women. All scales performed well: collectivism (α = .93, r = .85, p < .001); religiosity (α = .88, r = .89, p < .001); racial pride (α = .84, r = .52, p < .001); present time orientation (α = .73, r = .52, p < .01) and future time orientation (α = .72, r = .54, p = .07).

Spirituality, breast cancer beliefs and mammography utilization among urban African American women.

Spirituality has been shown to be associated with health, and is an important component in the lives of many African Americans. Recent research proposes that spirituality is a multidimensional construct. The present study proposes a two-dimensional model in which spirituality encompasses a belief and behavioral dimension. This hypothesis was examined, as were relationships between these dimensions and spiritual health locus of control, breast cancer beliefs and mammography utilization among African American women. The belief dimension played a more important role in adaptive breast cancer beliefs and mammography utilization that did the behavioral dimension. These findings suggest the importance of spiritual belief systems for health, and implications for spiritual cancer communication interventions are discussed.

Exploring Religion-Health Mediators among African American Parishioners

This qualitative study examined the religiosity-health association among African Americans, with particular attention to mediators through which religiosity positively impacts health. We conducted 31 interviews across seven African American churches of different Christian denominations. Semi-structured interviews were completed with male and female parishioners. Participants were asked to describe the religiosity-health association in their own terms, and if and how their beliefs and practices impact their health. They were also asked about specific mediators proposed in this literature, such as social support and coping with stress. Respondents spontaneously mentioned that church helps them through spiritual health locus of control, coping with stress, positive affect and scriptural influence on lifestyle. These mediators may hold promise for translation into church-based health interventions.

Role of religion in cancer coping among African Americans: A qualitative examination

The present study used qualitative methods to examine if and how African Americans with cancer use religiosity in coping. Patients (N = 23) were recruited from physician offices and completed 1–1½ hour interviews. Themes that emerged included but were not limited to control over ones illness, emotional response, importance of social support, role of God as a healer, relying on God, importance of faith for recovery, prayer and scripture study, and making sense of the illness. Participants had a great deal to say about the role of religion in coping. These themes may have utility for development of support interventions if they can be operationalized and intervened upon.

Use of Computer Kiosks for Breast Cancer Education in Five Community Settings

Finding ways to bring effective computer-based behavioral interventions to those with limited access to technology is a continuing challenge for health educators. Computer kiosks placed in community settings may help reach such populations. TheReflections of You kiosk generates individually tailored magazines on breast cancer and mammography and was adapted from an evidence-based intervention that increased mammography use in African American women. This usage study tracked patterns of use and characteristics of kiosk users in beauty salons, churches, neighborhood health centers, Laundromats, and social service agencies in St. Louis. Kiosks were used 4,527 times in 470 kiosk days at 40 different host sites. Highly significant differences among community settings were found in rates and patterns of kiosk use as well as user characteristics, breast cancer knowledge, and use of mammography. Findings inform strategic decision making about technology dissemination and community outreach to women needing information about breast cancer and mammography.

The role of religiosity in dietary beliefs and behaviors among urban African American women.

The relationship between religiosity and health has been investigated in many studies, with most finding positive associations. However, little is known about the role of religiosity in dietary factors, particularly among African American women. We used a self-administered questionnaire to examine the association between religiosity and dietary beliefs and behaviors among African American women. Women with strong religious beliefs and behaviors reported more interest in eating more fruits and vegetables, perceived their consumption as being more important, and consumed more fruits and vegetables than women low in religious beliefs and behaviors. These findings highlight the role of both religious beliefs and behaviors as they relate to diet-related beliefs and behaviors in this population.

Development of a Spiritually Based Educational Intervention to Increase Informed Decision Making for Prostate Cancer Screening Among Church-Attending African American Men

One way of developing culturally relevant health communication in the African American church setting is to develop spiritually based interventions, in which the health message is framed by relevant spiritual themes and scripture. In this article we describe the development of a community health advisor(CHA)-led intervention aimed at increasing informed decision making (IDM) for prostate cancer screening among church-attending African American men. Full-color print educational booklets were developed and pilot tested with extensive community participation of church-attending African American men age-eligible for screening. The intervention development phase consisted of ideas solicited from an advisory panel of African American men (N = 10), who identified core content and developed the spiritual themes. In the intervention pilot testing phase, prototypes of the intervention materials were pilot tested for graphic appeal in two focus groups (N = 16), and content was tested for acceptability and comprehension using individual cognitive response interviews (N = 10). Recommendations were made for project branding and logo and for use of graphics of real people in the educational materials. Significant feedback was obtained from the focus groups, on the graphics, colors, fonts, continuity, titles, and booklet size/shape. The importance of working closely with the community when developing interventions is discussed, as well as the importance of pilot testing of educational materials.

Use of focus group data to develop recommendations for demographically segmented colorectal cancer educational strategies

Screening is available and effective in colorectal cancer (CRC) control, but underutilized. The purpose of this study was to use focus group data to develop recommendations for the development of educational interventions to increase CRC screening, using an audience segmentation strategy. Demographic segments were based on urban-rural residence, race (African-American, White) and sex. One hundred and sixty-five participants age 50+, with no history of CRC participated in 17 focus groups in Alabama urban and rural communities. Transcripts were examined by independent coders. Knowledge among participants was limited regarding age to begin screening, insurance coverage and risk factors for CRC. Perceived barriers to screening included lack of physician recommendation, cost/lack of insurance coverage, pain/discomfort and embarrassment. African-American men reported postponement in seeing their physicians. White women were proactive at initiating discussion of CRC screening with their providers while African-American women felt that providers should drive the process. No urban-rural differences were identified. This study identified cultural and gender characteristics and perceptions that can be used in the development of demographically segmented health communication interventions to increase CRC awareness and screening.

Spiritually Based Intervention to Increase Colorectal Cancer Screening Among African Americans: Screening and Theory-Based Outcomes From a Randomized Trial

Colorectal cancer screening has clear benefits in terms of mortality reduction; however, it is still underutilized and especially among medically underserved populations, including African Americans, who also suffer a disproportionate colorectal cancer burden. This study consisted of a theory-driven (health belief model) spiritually based intervention aimed at increasing screening among African Americans through a community health advisor-led educational series in 16 churches. Using a randomized design, churches were assigned to receive either the spiritually based intervention or a nonspiritual comparison, which was the same in every way except that it did not contain spiritual/religious content and themes. Trained and certified peer community health advisors in each church led a series of two group educational sessions on colorectal cancer and screening. Study enrollees completed a baseline, 1-month, and 12-month follow-up survey at their churches. The interventions had significant pre–post impact on awareness of all four screening modalities, and self-report receipt of fecal occult blood test, flexible sigmoidoscopy, and colonoscopy. There were no significant study group differences in study outcomes, with the exception of fecal occult blood test utilization, whereas those in the nonspiritual intervention reported significantly greater pre–post change. Both of these community-engaged, theory-driven, culturally relevant approaches to increasing colorectal cancer awareness and screening appeared to have an impact on study outcomes. Although adding spiritual/religious themes to the intervention was appealing to the audience, it may not result in increased intervention efficacy.