Determining Health: Using Dyadic Peer Support to Promote Health in African American Faith Communities
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.
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