Medical Inspection – Health Blog

At baseline, 21 of the 41 congregations identified agreed to participate, representing a variety of Christian and Muslim communities. These congregations served a total of about 9,600 persons, and congregation sizes ranged from 120 to 1,200 members. The follow-up period ranged from three-to-five years, although the median follow-up was four years.

Table 1 shows the demographic characteristics of participating congregations according to their relative size. On average, males comprised a third of all congregations, although in some, the proportion of males was as low as 20% and in others, as high as 45%, with smaller congregations reporting smaller numbers of male members. The age composition was somewhat similar among congregation categories. Small- and medium-sized congregations had most of their membership living in southeast Raleigh, NC. In larger congregations, more than 60% of the congregation membership lived elsewhere. buy antibiotics canada

Table 1. Demographic Characteristics of Congregations (n=21)

Table 2 shows the 10 most frequently identified health concerns at baseline and follow-up. At baseline, 19 of the 21 congregations reported obesity as the most prevalent health concern, regardless of congregation size. Seventeen of the 21 (81%) congregations reported a high-fat diet among congregants as a significant health concern, and low physical activity was reported as a major concern by 16 of 21 (76%). High-fat diets and low physical activity as health concerns were reported with higher frequency by the large and small congregations. Stroke and arthritis tended to be reported as health concerns by medium-and large-sized congregations. The high prevalence of stress was reported by 14 of the 21 (67%) congregation leaders; however, the relationship was inverse. As the size of the congregation increased, the number reporting stress as a health problem decreased. Another inverse relationship was found with the reporting of poor communication skills and poor relationships among congregation members (both at church and at home) whose reported frequency decreased with increasing size of congregation. Eleven of 21 (52%) congregations reported cancer as a significant health problem, and this concern was almost evenly distributed across congregation sizes. Diabetes and heart attacks ranked ninth and 10th, respectively, with congregation leaders identifying them as significant health concerns. Therefore, despite diabetes being the object of the Project DIRECT intervention for four years and the second most common cause of chronic disease morbidity among African Americans in North Carolina after heart disease, it was not perceived as serious among the congregation leadership at baseline in 1997.

Table 2. Ranking of 10 Most Frequently Identified Health Concerns at Baseline and Follow-Up

At follow-up in 2002, a third of the original 21 congregations were lost to follow-up, with 50% of the loss from small congregations. One congregation was lost in the medium-size category and two were lost in the large-size category. Despite these losses, there was a sizable difference in the ranking of the 10 most frequently identified health concerns among the 14 congregations that were contacted. At follow-up, congregation leaders identified diabetes as the most significant health concern in medium- and large-sized congregations, while only one small congregation ranked it as a primary health concern. Obesity and arthritis were ranked as the second and third most serious health concerns, and these were evenly distributed across congregation size. The rank of other health concerns, such as cancer, stress, stroke, and heart attacks, remained essentially unchanged. Poor communications, low physical activity, and diets high in fat were perceived as being of lesser importance. Thus, following health assessments conducted by the congregation leadership, diabetes was recognized as the most significant threat to the well-being of their congregations in large- and medium-sized congregations, while arthritis and communication problems took on importance in small congregations.

Table 3. Health Concerns Identified and Actions Taken by Congregation Size

Table 3 summarizes the activities congregations adopted to address health concerns identified at baseline, utilizing available resources in their congregation and immediate community by congregation size. Among the 14 congregation leaders, three types of health-promotion activities were planned and launched during the period 1997-2002. These activities included cooking demonstrations to decrease high-fat diets, exercise to increase physical activity, and counseling for a variety of reasons (including risk reduction of chronic diseases and to improve interpersonal communication skills). In general, cooking demonstrations tended to be launched by large congregations, while counseling programs tended to be more frequently launched in small- and medium-sized congregations. Cooking demonstration projects were launched in four of five large congregations, two of the five medium-sized congregations, and none of the small congregations. Exercise programs in the form of congregation or community walks, aerobics, and jazz services were reported by three of the five large congregations, two of the medium sized and two of the four small congregations. Counseling programs were launched by one large congregation, two of the five medium-sized, and three of the four small congregations. As expected, since most chronic diseases share risk factors, congregation leaders reported cooking demonstrations and exercise programs in response to their concerns about diabetes, arthritis, obesity, cancer, and stroke, or simply to decrease the prevalence of risk factors (including stress and high-fat diets) and to increase physical activity. Poor interpersonal communication skills were reported most frequently by small congregations, and as expected, three of the four congregations subsequently adopted counseling programs. Other activities, including formation of support groups to alleviate stress and anxiety, were reported by small- (n=2) and medium-sized (n=2) congregations.
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