Mark J. DeHaven

Health Programs in Faith-Based Organizations: Are They Effective?

OBJECTIVES We examined the published literature on health programs in faith-based organizations to determine the effectiveness of these programs. METHODS We conducted a systematic literature review of articles describing faith-based health activities. Articles (n = 386) were screened for eligibility (n = 105), whether a faith-based health program was described (n = 53), and whether program effects were reported (28). RESULTS Most programs focused on primary prevention (50.9%), general health maintenance (25.5%), cardiovascular health (20.7%), or cancer (18.9%). Significant effects reported included reductions in cholesterol and blood pressure levels, weight, and disease symptoms and increases in the use of mammography and breast self-examination. CONCLUSIONS Faith-based programs can improve health outcomes. Means are needed for increasing the frequency with which such programs are evaluated and the results of these evaluations are disseminated.

The GoodNEWS (Genes, Nutrition, Exercise, Wellness, and Spiritual Growth) Trial: A community-based participatory research (CBPR) trial with African-American church congregations for reducing cardiovascular disease risk factors — recruitment, measurement, and randomization

INTRODUCTION Although cardiovascular diseases (CVD) are the leading cause of death among Americans, significant disparities persist in CVD prevalence, morbidity, and mortality based on race and ethnicity. However, few studies have examined risk factor reduction among the poor and ethnic minorities. METHODS Community-based participatory research (CBPR) study using a cluster randomized design--African-American church congregations are the units of randomization and individuals within the congregations are the units of analysis. Outcome variables include dietary change (Diet History Questionnaire), level of physical activity (7-Day Physical Activity Recall), lipoprotein levels, blood pressure, fasting glucose, and hemoglobin A1c. RESULTS Eighteen (18) church congregations were randomized to either a health maintenance intervention or a control condition. Complete data were obtained on 392 African-American individuals, 18 to 70 years of age, predominantly employed women with more than a high school diploma. Treatment and intervention groups were similar at baseline on saturated fat intake, metabolic equivalent of tasks (METS) per day, and other risk factors for CVD. CONCLUSIONS The GoodNEWS trial successfully recruited and evaluated CVD-related risk among African-American participants using a CBPR approach. Several logistical challenges resulted in extending the recruitment, preliminary training, and measurement periods. The challenges were overcome with the assistance of a local community consultant and a professional event planner. Our experience supports the need for incorporating non-traditional community-based staff into the design and operational plan of CBPR trials.

Patient Perceptions of a Community-Based Care Coordination System

Community health workers (CHWs) work with health professionals to improve health outcomes by facilitating community-based health education and increase access and continuity to health services within a community. Uninsured, low-income participants of a community-based program, Project Access Dallas, participated in focus group sessions for determining participants’ perceptions of CHW effectiveness and participants’ abilities to independently manage their health needs. Of the 95 adults invited, 24 (25.3%) attended. Participants reported that CHWs are an invaluable asset in learning how to navigate the health care system, obtaining appointments and being better able to care for themselves with CHW emotional/psychological support. Results suggest that CHWs in a case management model improved patient comprehension of health issues, patient navigation through a health care system, and patients’ abilities to independently manage health issues. Implementation of CHWs within a case management model appears to be an effective mechanism for providing health services to underserved populations.

The effects of a community-based partnership, Project Access Dallas (PAD), on emergency department utilization and costs among the uninsured

BACKGROUND Approximately 19% of non-elderly adults are without health insurance. The uninsured frequently lack a source of primary care and are more likely to use the emergency department (ED) for routine care. Improving access to primary care for the uninsured is one strategy to reduce ED overutilization and related costs. METHODS A comparison group quasi-experimental design was used to evaluate a broad-based community partnership that provided access to care for the uninsured-Project Access Dallas (PAD)-on ED utilization and related costs. Eligible uninsured patients seen in the ED were enrolled in PAD (n = 265) with similar patients not enrolled in PAD (n = 309) serving as controls. Study patients were aged 18-65 years, <200% of the federal poverty level and uninsured. Outcome measures include the number of ED visits, hospital days and direct and indirect costs. RESULTS PAD program enrollees had significantly fewer ED visits (0.93 vs. 1.44; P < 0.01) and fewer inpatient hospital days (0.37 vs. 1.07; P < 0.05) than controls. Direct hospital costs were ∼60% less (

The Cardiovascular Health of Urban African Americans: Diet-Related Results from the Genes, Nutrition, Exercise, Wellness, and Spiritual Growth (GoodNEWS) Trial

1188 vs.

Reaching Out to Those in Need: The Case for Community Health Science

446; P < 0.01) and indirect costs were 50% less (

Churches as targets for cardiovascular disease prevention: comparison of genes, nutrition, exercise, wellness and spiritual growth (GoodNEWS) and Dallas County populations

313 vs.

Fostering a Culture of Prevention in a Residency Program Through a Continuous Quality Improvement Project

692; P < 0.01). CONCLUSIONS A broad-based community partnership program can significantly reduce ED utilization and related costs among the uninsured.

Prevalence of Diabetes and Health-Related Quality of Life Among Rural-to-Urban Nong Zhuan Fei Migrants in an Urban Area of Northern China, 2013.

African Americans have a higher incidence of cardiovascular disease (CVD) than Americans in general and are thus prime targets for efforts to reduce CVD risk. Dietary intake data were obtained from African Americans participating in the Genes, Nutrition, Exercise, Wellness, and Spiritual Growth (GoodNEWS) Trial. The 286 women and 75 men who participated had a mean age of 49 years; 53% had hypertension, 65% had dyslipidemia, and 51% met criteria for metabolic syndrome. Their dietary intakes were compared with American Heart Association and National Heart, Lung, and Blood Institute nutrition parameters to identify areas for improvement to reduce CVD risk in this group of urban church members in Dallas, TX. Results from administration of the Dietary History Questionnaire indicated median daily intakes of 33.6% of energy from total fat, 10.3% of energy from saturated fat, 171 mg cholesterol, 16.3 g dietary fiber, and 2,453 mg sodium. A beneficial median intake of 2.9 cups fruits and vegetables per day was coupled with only 2.7 oz fish/week and an excessive intake of 13 tsp added sugar/day. These data indicate several changes needed to bring the diets of these individuals--and likely many other urban African Americans--in line with national recommendations, including reduction of saturated fat, sodium, and sugar intake, in addition to increased intake of fatty fish and whole grains. The frequent inclusion of vegetables should be encouraged in ways that promote achievement of recommended intakes of energy, fat, fiber, and sodium.

Perspectives on Adherence to Recommended Health Behavior among Low-Income Patients

The present health care delivery model in the United States does not work; it perpetuates unequal access to care, favors treatment over prevention, and contributes to persistent health disparities and lack of insurance. The vast majority of those who suffer from preventable diseases and health disparities, and who are at greatest risk of not having insurance, are minorities (Native Americans, Hispanics, and African Americans) and those of lower socioeconomic status. Because the nations poor are most affected by built-in inequities in the health care system and because they have little political power, policy makers have been able to ignore their responsibility to this group. Family medicine leaders have an opportunity to integrate community health science into their academic departments and throughout the specialty in a way that might improve health care for the underserved. The specialty could adapt existing structures to better educate and involve students, residents, and faculty in community health. Family medicine can also involve community practices and respond to community needs through practice based research networks and community based participatory research models. It may also be possible to coordinate the community activities of family medicine organizations to be more responsive to the health crisis of those in need. More emphasis on community health science is consistent with family medicines roots in social reform, and its historical and philosophical commitment to the principle of uninhibited access to medical care for the underserved.