PARTNERS FOR HEALTHY LIFESTYLES

Barbara Jackson-Marshall RN, MPH, CHES

Assistant Director For Prevention Programs

Tim Powell, MPH Mark Levine, MD, MPH

Epidemiologist District Health Director

Piedmont Health District/Virginia Department of Health

Farmville, VA

VIRGINIA & PIEDMONT HEALTH DISTRICT

PIEDMONT DEMOGRAPHICS• Seven counties, of approximately 2830 square

miles, with a total population of 97,103. – 34.3 persons per square mile.

• 36 percent of Piedmont residents are African American, and 2 percent are of other non-white race.

• Average median household income for the district is $31,563.– 17.2 percent of residents live below the poverty level. – Unemployment rate of 4.7 in 2002.

• All 7 counties listed as Medically Underserved Areas, 5 as Healthcare Provider Shortage Areas.

Demographics Cont.

• 30.1 percent of Piedmont residents suffer from obesity, an estimated 22,592 persons.

• 8.6 percent of Piedmont adults suffer from diagnosed diabetes, an estimated 6,455 persons.

RATIONALE CVD is a significant public health concern in our

rural health community. Compared to the state and nation, these residents

are more likely to be poor, African American, and have difficulty accessing medical care.

African-Americans in Piedmont are significantly more likely than whites to be overweight, poor, and have sedentary lifestyles.

African-Americans have higher rates of mortality from chronic diseases, particularly cardiovascular disease.

RATIONALE

The health disparities are wider than that of Virginia and the United States.

The Church serves as both the principal meeting area and key motivator for change amongst Piedmont’s African-American adult population.

PARTNERS FOR HEALTHY LIFESTYLES 2000

The District investigated whether a faith-based intervention could

reduce cardiovascular risk factors.

GOAL: INCREASE HEALTHY YEARS OF LIFE

OBJECTIVE:

To educate and support participants to change, improve and maintain healthy behaviors by reducing fat intake and increasing physical activity to 3 days a

week for at least 20 minutes a day.

*Note: This has changed to 5 days a week for at least 30 minutes a day.

METHOD• Phase I - Introduction

Form partnerships with African American churches within the health district.

Churches were recruited to participate in the PHL program. Selected and trained volunteer Lay Health Workers (LHW)

to facilitate the church meetings and assist with collecting data, monitoring progress, and serve as the “motivator”.

Participants enrolled and frequency and dates for meeting times established.

Establish Buddy system. Baseline data collected and self reported medical history

taken.

INDICATORS

Church participation ( minimum of 12 participants) – family is encouraged to attend

Body Mass Index Waist circumference Dietary fat intake - self report form Physical activity level – self report log

METHOD• Phase II - Education intervention on Cardio-

vascular Risk factors Nutrition – “Managing Soul Food” “Praisercise” – engage participants in physical

activity and walking to gospel music Gospel Aerobics” soft aerobics at weekly meetings Attempted to overcome cultural dietary and exercise

norms Other Risk factors – Hypertension, Cholesterol,

Diabetes

Phase II continued

Subject chosen by participants Sharing Activity - Engaged the participants into a

“mind set” that CVD is a significant health issue and that its effects are modifiable.

Introduced to monitoring/tracking logs for physical activity, dietary fat intake and Personal Commitment Goal

Incentives were used as motivators for successes at intervals and for completion of the program.

METHOD

• Phase III - Maintenance Period Participants record their dietary fat intake and

physical activity weekly LHW collects data, supports and motivates

participants to decrease fat intake and increase physical activity

District program manager and part time program coordinator worked with the LHW

Change In Cardiovascular RisksBMI, PHD 2000

65%

22%

13%

79%

17%

8%

38% 38%

25%

58%

47%

11%

60%

10%

30%

63%

20%17%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Church of

Christ

Sharon

Baptist

High Rock Gravel Hill Bible Way All

Churches

Decreased No Change Increased

Change in Cardiovascular RisksWaist (inches), PHD 2000

78%

17%

4%

92%

0%8%

88%

0%

13%

95%

5%0%

50%

10%

40%

83%

7% 10%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Church of

Christ

Sharon

Baptist

High Rock Gravel Hill Bible Way All

Churches

Decreased No Change Increased

Change In Cardiovascular RisksDietary fat (%calories), PHD 2000

78%

13%9%

96%

0% 4%

100%

0% 0%

95%

0% 5%

70%

20%

10%

88%

6% 6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Church of

Christ

Sharon

Baptist

High Rock Gravel Hill Bible Way All

Churches

Decreased No Change Increased

Change In Cardiovascular RisksExercise (> 20 minutes/day,3 days/week),

PHD 2000

4%

100%

0%

100%

0%

100%

0%

100%

0%

90%

1%

99%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Church of

Christ

Sharon

Baptist

High Rock Gravel Hill Bible Way All

Churches

Baseline Follow-up

FY 2000 Church Locations

FY 2000-2003 Church Locations

BARRIERS/CHALLENGES Isolation Small church congregations Lack of Interest Difficulty conceptualizing the relationship between

church and personal health Establishing trust and credibility Rural setting – lack of public transportation Collaboration among churches was complicated Pastors do not live in the community. The Pastor may

minister more than one church. Sustainability – LHW were trained to continue the

program the following year. Pastors supported continuing the program.

Practices that created a spiritual basis, spiritual support, spiritual guidance, fellow encouragement,

and helped participants accept, but into, and perceive long term changes to improve

personal/family health behaviors. Courtship” with churches during the months of

June – August. District and the Church identified scriptures that

connected the principles of the program to the individual church doctrine.

“M & M Break” “Motivation & Meditation Break” - “affirmation” of good health and healthy body which stemmed from one of the scriptures.

“ Prayer Partner” – support person

LESSONS LEARNED

Importance of meeting people “where they are”. Listen - Enter the individual church with the approach

of “how can I help you” and paying attention to the health/needs of the individual congregation.

Get the Pastor’s sanction and members want him and/or his wife actively involved in the program.

Operate within the culture and practices of each individual church/faith-based organization.

Establish trust and credibility Don’t promise something that you can’t deliver. Open and honest communication.

SUSTAINABILITY LHW were trained to continue the program the

following year. Pastors supported continuing the program

Overcome funding decreases by expanding the partnerships to local organizations to promote centralized locations.

Work with local schools and fitness centers to provide community opportunity for physical activity

Get community support to expand the program, get a champion and/or advocates for the program

Seek other grant funding

Keys To Success As Reported by the Focus Group Belief in the methods Belief in the connection between health and religion Good health is determined by behavior change and

consistency The body is sacred; take care of it through good

nutrition and eating habits Monitoring food intake is more important that

dieting (fads) Weight control and exercising/physical activity

require persistence and consistency The PHL program can result in life long or long

term outcomes

• Healthy bodies come in all sizes

CONCLUSION

FAITH- BASED INTERVENTIONS ARE A COMPELLING AND POWERFUL FORCE OF LIFESTYLE BEHAVIOR CHANGE IN

RURAL AFRICAN-AMERICAN COMMUNITIES

Change in Average Weight by Year, Partners for Healthy Lifestyles Program,Piedmont Health District

-1.6%

-4.9%

-2.1%

-1.8%

170

175

180

185

190

195

200

205

210

215

Poun

ds

Baseline 200.8 188.1 210.9 203.1

Follow-up 197.3 184.1 200.4 199.7

2000 2001 2002 2003

Change in Average Body Mass Index by Year,Partners for Healthy Lifestyles Program,

Piedmont Health District-3.4%-6.3%

-3.2%

-1.8%

27.0

28.0

29.0

30.0

31.0

32.0

33.0

34.0

35.0

36.0

Bod

y M

ass

Inde

x

Baseline 33.2 31.0 34.9 35.0

Follow-up 32.6 30.0 32.7 33.8

2000 2001 2002 2003

Change in Average Waist Inches by Year, Partners for Healthy Lifestyles Program, Piedmont Health District

-2.9%

-3.2%

-3.7%-4.4%

34

35

36

37

38

39

40

41

42

43

Inch

es

Baseline 38.4 38.2 40.2 41.8

Follow-up 36.7 36.8 38.9 40.6

2000 2001 2002 2003