Browsing by Author "Lipkus, Issac"

African Americans face persistent health inequities. Obesity is linked to multiple chronic disease conditions and prevalence has climbed sharply in the last decades (Budd & Peterson, 2014; Samuel-Hodge et al., 2009) – especially for African Americans. African American churches and relationships between its members are trusted community resources that support and promote health. Health disparities are best addressed by understanding and optimizing resources, such as churches, within environments where people live, work, play and pray. Dyadic peer support has been used successfully to promote weight loss and improve diabetes management. It is recommended as a potential health promotion strategy for African Americans. This dissertation explored the concept of religious social capital as a health promoting asset, and the feasibility of using dyadic peer support to promote healthy weight in African American churches. To our knowledge, using dyadic peer support to promote healthy weight among members in African American churches has not been explored. The Transactive Goal Dynamics Model, Community Empowerment Theory, and the Socioecological Model provided the theoretical framework for this dissertation.

Religious social capital is a significant contributor to the health of individuals and communities, particularly among African Americans and ethnic minorities. A concept analysis of religious social capital within the context of health was conducted. Rogers Evolutionary Concept Analysis method was used. The analysis identified antecedents, attributes, and consequences of religious social capital. An operational definition, including bonding, bridging, and linking types of religious social capital, was developed. The analysis provided a basis to better understand how religious social capital can be utilized to improve health in populations experiencing health disparities.

In Chapter three, formative research was conducted to explore African American church members’ and health educators’ perceptions of using dyadic peer support to promote healthy weight in African American churches. From 2017-2018, researchers conducted 21 semi-structured interviews to better understand perceptions of using a dyadic peer support program to promote healthy weight. Seventeen African American church members four county and regional health educators from North Carolina were interviewed. Conventional qualitative content analysis was used to analyze the data and identify themes across cases. Key themes included: (1) the church and health are intertwined (2) working in pairs is natural and beneficial; (3) members want to help and be helped; (4) attitude and motivation are important considerations for dyads; and (5) dyad activities should be structured and frequent. The study showed that because of strong ties and relationships, participants felt churches were fertile ground for using dyadic support to promote healthy weight.

In Chapter four, a prospective multi-method 18-week pre post study was completed to determine the feasibility of using dyadic peer support to augment an existing healthy weight program in African American churches. Descriptive statistics, multilevel models, and semi-structured interviews were used to assess 1) program feasibility, 2) changes in weight, blood pressure, fruit and vegetable intake and physical activity, and 3) how dyad partners cooperate to achieve their health goals. Eighty participants from three churches in three counties in North Carolina enrolled.

The program completion rate was 78%. Over 95% of participants report wanting to work with a partner again. Participants achieved small but significant average increases of 1.1 servings of fruit (p value=0.001) and 1.2 days (p value=0.01) of 30 minutes of physical activity pre and post intervention. There were no significant changes in weight, systolic blood pressure, BMI, or vegetable intake from baseline to 18 weeks. Significant changes in weight (-2.6 pounds, 95%CI= -4.18, -1.1, p-value= 0.001) and vegetable intake (0.681 servings, 95%CI= 0.122, 1.241, p value=0.017) achieved during the first nine weeks of the program were maintained during the second nine weeks. Dyads were strongest at developing team goals, communicating weekly, and providing motivation in the form of encouragement. Dyads had difficulty identify solutions to goal attainment challenges and finding consistent times to communicate. This study indicated that it is feasible to implement a dyadic peer support program to promote healthy weight within African American churches. Future programs should help dyads identify consistent times to meet, and improve problem solving to overcome challenges by initiating partnering earlier during the program, and tapering group meeting frequency more slowly.

African American churches and relationships between members are community assets that promote health. Dyadic peer support programs may optimize these relationships to improve health promotion programs. Additional dyadic peer support studies including control groups are needed to better understand their effects and sustainability. If found effective, they may be used as an adjunct to various community-based health promotion programs to address health equity. Additional community assets and unique characteristics of different African American communities should be considered when designing health promotion programs.

Most breast cancer survivors do not exercise enough to experience its numerous benefits that include improved quality of life and decreased recurrence risk. A potentially effective strategy to increase exercise among this population is to increase their outcome expectations (OEs). OEs are what one expects to obtain or avoid by engaging in a behavior. OE dimensions include 1) importance - value placed on the outcome(s); 2) certainty - perceived probability outcome(s) will occur; and 3) accessibility - frequency with which outcome(s) are considered. The purpose of this dissertation is to develop knowledge on the impact of OEs on exercise in breast cancer survivors. This is achieved through three independent studies. First, an exploratory study to identify common OEs among breast cancer survivors. Secondly, through a measurement study, in which a scale is created and pilot tested to measure OE dimensions. Finally, an intervention is created in collaboration with active breast cancer survivors and pilot tested in a randomized controlled trial among 60 breast cancer survivors. Findings from this dissertation indicate that breast cancer survivors are overwhelmingly unaware of the extent to which exercise can benefit them. Fortunately, findings from this dissertation also indicate that the tested strategy to increase OEs is both feasible and effective among breast cancer survivors. Finally, this dissertation contributes a measure to assess intervention effects on multiple OE dimensions. In summary, findings from this dissertation indicate that targeting OEs is an effective strategy to improve the quality and duration of breast cancer survivorship and future work in this area is warranted.

A disproportionate number of non-Hispanic Black men and women in the United States (U.S.) suffer from diet-related chronic diseases, including overweight and obesity, hypertension, and diabetes compared to other racial groups. Given that most Black adults in the U.S. identify as Christian and the church is a trusted and prominent institution in the community, health promotion interventions among Black Christians have been prioritized to address diet-related health disparities impacting this population. To persuade participants to eat healthier, existing interventions have targeted an important element of behavior change: healthy eating beliefs. In particular, the benefits that result from one’s healthy eating choices. However, current methods have constraints regarding which aspects of beliefs they address, specifically in terms of belief referent (i.e., individualistic versus prosocial) and belief number (i.e., fewer versus more), as well as the persuasion technique (i.e., direct persuasion versus self-persuasion) used to convey beliefs to participants. These limitations potentially restrict the full potential for beliefs to promote healthy eating. The purpose of this dissertation was to refine messaging strategies that target healthy eating beliefs to enhance the efficacy of existing healthy eating interventions among U.S. Black Christians aimed at reducing diet-related chronic health diseases. Chapter 1 of this dissertation introduces the health-related problem, gaps in existing healthy eating interventions, and the Theory of Planned Behavior underpinning this dissertation. Chapter 2 is a qualitative descriptive study exploring healthy eating beliefs, specifically perceptions of food, faith, and health, among a multiracial sample of U.S. Christians. Findings described four themes: (1) Healthy eating is a lifestyle; (2) Shifting from food as fuel to food for holistic health; (3) Prosocial flourishing: One’s food choices affect us all; and (4) Healthy eating is faithful eating. Theme 1 subthemes consisted of participant descriptions of (a) balanced food choices, (b) intentional eating behaviors, and (c) dominant cultures shaping universal definitions of healthy eating. Theme 2 subthemes demonstrated participant perceptions of holistic health including (a) physical health, (b) mental and emotional health, (c) social health, and (d) environmental health. In Theme 3, participants described how healthy eating benefits extended beyond personal gain to encompass the larger community. In Theme 4, participants aligned their eating habits with faith values of sanctity, stewardship, fellowship, justice, and forgiveness and compassion, illuminating the notion that healthy eating is faithful eating.

Chapter 3 comprised of two feasibility studies to pilot test instructions of a web-based belief elicitation experiment manipulating two factors, belief referent (individualistic v. prosocial) and belief number (2 v. 6) among two separate web-based samples of U.S. Black Christians (Pilot 1: N = 100; Pilot 2: N = 60). The main finding from Pilot 1 suggested a need to strengthen the manipulation of belief referent, demonstrated by people in the prosocial conditions not providing the correct referent, self and others, in their written responses to the belief elicitation. Instructions were refined according to participant recommendations and tested in a second pilot study. Pilot 2 demonstrated improvements in instruction comprehension and manipulation check measures, particularly for the prosocial referent group, indicating it was appropriate to conduct the main trial with no further changes to study methods.

Chapter 4 was a between-subjects randomized controlled trial to test the effect of belief referent (individualistic v. prosocial) and belief number (2 v. 6) on healthy eating intentions, attitudes, and behaviors among a web-based sample of U.S. Black Christian adults (N = 400). Findings revealed no condition group effect on post-test healthy eating attitudes and intentions (Aim 1). Additionally, there was no evidence of healthy eating attitudes mediating any group effect on post-test healthy eating intentions (Aim 2). However, the second aim did confirm healthy eating attitudes was a significant predictor of post-test healthy eating intentions. Additionally, results indicated that post-test healthy eating intentions correlated positively with self-reported healthy eating behavior at the one-week follow-up (Aim 3).

Chapter 5 concludes the dissertation by synthesizing the entirety of findings across all chapters and discussing the implications and future research recommendations. This dissertation contributes to new insights for nursing, public health, and theology researchers and practitioners aiming to motivate people of faith to engage in healthy eating behaviors. The synthesis of findings suggest further work is necessary to confirm the relevancy and effects of holistic, prosocial, and faithful approaches to dietary health promotion for Christians. Beliefs remain an integral part of health promotion and behavior change to address the high rates of chronic disease in our nation. Future research efforts aimed at identifying effective healthy eating beliefs among diverse samples of Christians and testing their integration into comprehensive healthy eating interventions could strengthen the science of faith-based health promotion.