Refining Messaging Strategies to Increase Efficacy of Healthy Eating Interventions Among U.S. Black Christians

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.