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TRANSCRIPT
Recruiting and Retaining African
American Participants in
Chronic Disease Self-
Management Education (CDSME)
Program Workshops Delivered in
Faith-Based Organizations
Chivon A. Mingo, PhD
Tiffany R. Washington, PhD, MSW
Kathleen Cameron, MPH
Angelica Herrera-Venson, DrPH, MPH
Kristie Kulinski, MSW
Matthew Lee Smith, PhD, MPH, CHES
Partner Recognition
Background • Aging African Americans are at a greater risk of chronic
disease diagnosis and burden
• Aging African Americans are oftentimes underrepresented in utilization of evidence-based chronic disease self-management programs similar to CDSME
• Research consistently highlights lack of inclusion and participation of aging African Americans in health-related research, clinical trials, and behavioral interventions
Background • To overcome such challenges, research has focused its
efforts on working with faith-based organizations (FBOs)
• Implementing programs within faith-based organizations effectively increases utilization of health promotion programs (in general) for African Americans
• FBOs are the 5th leading delivery site type for Chronic Disease Self-Management Education (CDSME) programs nationwide
Background • African Americans have reported a preference toward
participating in CDSME programs offered at FBOs, yet data show that FBOS oftentimes have the smallest proportion of program participants
Background
• Important Points of Consideration
• Does this preference translate into program attendance?
• Does this preference translate into completion of the program?
• Among African Americans, what truly influences attendance and completion of CDSME program workshops in FBOs?
CDSMP/DSMP(https://www.selfmanagementresource.com)
• Participants gain the knowledge, skills, and necessary support to take control of their health and make healthy lifestyle changes
• 6 workshop sessions held once a week
• Each session 2 ½ hours, highly interactive
• Co-facilitated by two trained leaders, one of whom has an ongoing health condition
• Core content:• Symptom management/social role function
• Coping techniques (fatigue, frustration, isolation, sleep)
• Exercises to build self-efficacy
• Problem solving to overcome challenges
• Goal setting and action plans
Research Objectives
• To describe personal characteristics and workshop attributes associated with the national dissemination of CDSMP and DSMP to African Americans in FBOs
• Who is attending and why or why not?
• To identify factors associated with successful workshop completion (i.e., attending 4+ of 6 workshop sessions) among CDSMP/DSMP participants attending at a FBO
• Who is completing?
• To discuss strategies for recruiting, engaging, and retaining African Americans in CDSME workshops offered in FBOs
• Can preference meet attendance and completion; If so, how?
• Informed by a supplemental qualitative research study
Data
• Data analyzed from African American CDSMP and DSMP participants who attended workshops in faith-based settings
• Administrative records and a brief baseline questionnaire
• Analyses of 5,302 participants with complete data
• 752 workshops
• 38 states
• Data Analyses
• Chi-square tests
• Independent sample t-tests
• Binary logistic regression
• Significance: P < 0.05
Measures
• Dependent Variable
• Workshop attendance: Attending 4+ of 6 sessions
• Personal Characteristics
• Age, Sex, Live alone, Rurality
• Health Indicators
• Self-reported chronic conditions (e.g., heart disease, diabetes)
• Workshop Characteristics
• Number of participants enrolled in the workshop (0 to 20)
Sample Characteristics• 71% CDSMP; 29% DSMP
• On average, 4.6 sessions attended
• 81% attended 4+ sessions
• On average, age 65.0 years
• 82% female
• 63% lived with others
• 15% resided in a rural area
• On average, 2.5 chronic conditions
• 66% hypertension
• 43% arthritis
• 43% diabetes
• 17% breathing /lung disease
• 11% anxiety /depression
• 9% cancer
Successful Completion
SUCCESSFULLY COMPLETING WORKSHOP SESSIONS (4+ of 6)…
• More likely
• Older
• Female
• Less likely
• Attended DSMP (relative to CDSMP)
• Resided in rural area
Conclusion• FBO may not be the single factor that leads to increased uptake
of CDSME programs among African Americans
• Yet, there is great potential for FBOs to reach this unique and traditionally underserved population
• Additional efforts are needed to enhance FBO adoption of CDSME programs as well as recruit and retain African American participants
• Understanding how to leverage the partnership with FBOs in effort to recruit, engage, and retain African American participants will require consideration of “what matters”
Building on Existing Knowledge
Funding Support: National Institutes on Health, 5P30AG015281, and the Michigan Center of Urban African American
Aging Research
Supplemental Research Study
Participants• 50 African Americans• 6 Atlanta Metropolitan Area FBOs (see next slide)• Age: 50+• Doctor-diagnosed Chronic Conditions
Procedure• Targeted Recruitment Strategies - FBOs• CDSMP• Focus group
Faith Based Organizations
FBO Demographics
• Predominantly African American Congregation
• Historical Importance
• Founded as early as 1853
• 5 Megachurches (≥ 2,000 Congregants)
• Various Denominations
• 3 Baptist, 1 Methodist, 1 African Methodist Episcopal, 1 Church of Christ
• Staple in the Community
Recruitment Lessons Learned Strategies for Recruiting, Engaging, & Retaining FBOs
Consider the Importance of the FBO’s Reputation in the Community
Gain Insight of the Culture from the Clergy/Ministry Leaders
Evaluate the FBOs Experience with Programs of this Type
Inquire about Competing Programs/Services/Events
Evaluate Baseline for FBO Members’ Involvement
Evaluate Baseline for CommunityInvolvement in FBO Activities
Understand the Barriers and FacilitatorsAssociated with Geographic Location (i.e., Rural vs Urban)
Consider Transportation Access
Consider Cost Determine Health Priority and Frequency of Health Related Focused Programs
Build Rapport with Gatekeeper to the FBO, congregation, and Greater Community
Strategize about Widespread Adoption amongst a specific FBO Network
Can Preference Meet Attendance and Completion?
Voices of the Participants
“…where as you are familiar with your own church. You come here every Sunday and you know this church …you know we all live…across the town so is no problem because we come over here anyway. This is our church so we know where it is so people don’t mind coming there all day [Preference].”
“You know it was easy to come to the same place I normally come to [Preference].
“Would be kinda hard. You know we very territory. [Another Participant Follows] Especially when you talk about churches. If you did it at a different facility say within the neighborhood ughh it might be ughh easier to consider it that way [Preference].”
Recruitment Lessons Learned Strategies for Recruiting, Engaging Retaining Participants through FBOs
Establish willingness to Attend at Home FBO vs. Community FBO
Be Aware of Denomination Barriers
Clearly Articulate the Product/Program Being Offered
Consider Innovative Ways to AttractParticipants in Addition to “The Joiners”
Provide Culturally Relevant and Sensitive Information that Resonates with the Target Audience
Consider the Impact of Program Cost
Program Type (Disease Specific vs. MCC)
Provide Access to Materials Throughout the Workshops and Beyond
Consider the FBO Service/Event Schedule
Consider the Timing of the Workshops Build Rapport with Gatekeepers
Build Rapport with the Workshop Participants
Be Mindful of the Impact of Naming
Identify and Minimize Age-related Barriers
Consider Gender Differences in Engagement
Recruitment, Engagement, and Retention
Voices of the Participants“ I just hate the lack of participation [Recruitment, Retention]. I really hate that because it was, because it was so valuable we have so many “Jewels” and “Partners” at this church. I am a “Partner”, most of them are “Jewels” but this information all of them really needed to hear this [Engagement].”
“Unclear when I saw it in the church bulletin [Recruitment] and it was being held at the church, and then I looked ---arthritis and diabetes [Recruitment]…I didn’t know anything at all about the program, you remember I objected until my daughter [Recruitment]---- I went and signed up but [Name Redacted], my daughter, she said she wanted to take me because she felt it was something good So she brought me and – I signed up [Recruitment and and I have enjoyed it [Recruitment, Retention, Engagement]….I established a relationships with the other members so that is my point [Engagement, Retention]. It’s a good program, a very good program.”
Recruitment, Engagement, and Retention
Voices of the Participants“I’m always interested in classes [Recruitment] but when they are free, I am more interested because then there is less money out of my pocket and I am still getting valuable information [Recruitment]… we got the book free and they told us that we could keep the book [Engagement, Retention] Because I wouldn’t even write on it. I said wait a minute let me ask before I put my name on this book but then we were told that we could actually keep the book. That’s very significant [Engagement, Retention] .”
Recruitment, Engagement, and Retention
Voices of the Participants“I was very …disappointed that we didn’t have participants …so I went around to various ones to --- ask them about coming, why are you not coming and some of them could not commit …six weeks…not in the summer months because like…so many activities… that is having right here [at the church]. …grandkids…they want to spend time with…out of school----- so my suggestion is that have it shorter term like four weeks at a time and …the Fall [Recruitment, Retention, Engagement].
“…you know accountability is critical for somebody like me who puts off and finds everything to do but if you are accountable to somebody …like you know when your student called me, …you know she just talked to me so when I got up this morning and eh you know,…I said ok you need to move along with this …accountability is everything for me personally [Retention, Engagement].
Recruitment, Engagement, and Retention
Voices of the Participants“[Name Redacted] did announce it at our board quarterly meeting about signing-up, nobody signed up because it was nothing there to encourage to us to sign- up, you see what am saying [Recruitment]?”
“I think we need to take that chronic conditions off [Recruitment].”
“See you deal with the spirit part of the church but you also got to deal with that physical part so there has to be a balance and by having it here at the church, …and that is where you catch a lot of us [Recruitment, Retention, Engagement].”
Recruitment, Engagement, and Retention
Voices of the Participants“I think too you should invite another church. There are other churches around here [Recruitment, Engagement].”
“The only reason I signed up for the six weeks is, is [Name Redacted] said she was having a class. And I’m telling the truth, [Name Redacted] said she was having a class and it was about umm chronic conditions and she said your husband got diabetes [Recruitment] .”
Recruitment, Engagement, and Retention
Voices of the Participants
[Male Participants] “I say you made me enlist you know when you came and presented to the group and all. I said here we got a young Black woman that’s intelligent, that knows what she’s talking about, and she’s out to help us, you know that was very good to me because you knew what you were talking about. You knew some stuff, and you presented well [Recruitment].” “So yeah, I would agree. I actually thought you were teaching the class.” “Yeah we did. Fit my profile. It …I said, she attractive and smart.”
“I call it man up. Man up living with chronic diseases something to that [Recruitment].
Recruitment Lessons Learned Strategies for Recruiting, Engaging Retaining Participants through FBOs
Establish willingness to Attend at Home FBO vs. Community FBO
Be Aware of Denomination Barriers
Clearly Articulate the Product/Program Being Offered
Consider Innovative Ways to AttractParticipants in Addition to “The Joiners”
Provide Culturally Relevant and Sensitive Information that Resonates with the Target Audience
Consider the Impact of Program Cost
Program Type (Disease Specific vs. MCC)
Provide Access to Materials Throughout the Workshops and Beyond
Consider the FBO Service/Event Schedule
Consider the Timing of the Workshops Build Rapport with Gatekeepers
Build Rapport with the Workshop Participants
Be Mindful of the Impact of Naming
Identify and Minimize Age-related Barriers
Consider Gender Differences in Engagement
Conclusion
• Understanding how to leverage the partnership with FBOs in effort to recruit, engage, and retain African Americans will require consideration of “what matters”
• There is no “one-size fits all” approach; therefore, collecting data to understand “what matters” is imperative to maximize impact of evidenced-based CDSME programs
• Ultimately, increasing recruitment, engagement, and retention of African Americans in CDSME programs could reduce chronic-disease burden among a disadvantaged population
THANK YOU!
Chivon A. Mingo, PhD
Georgia State University
Matthew Lee Smith, PhD, MPH, CHES, FAAHB, FGSA
Center for Population Health and Aging
Texas A&M University
The University of Georgia