Refining a Church-Based Lifestyle Intervention Targeting African-American Adults at Risk for Cardiometabolic Diseases: A Pilot Study

Abstract

Objective: The pilot study was intended to test the feasibility of a multiple-component lifestyle intervention targeting African American adults in a weight control and cardiometabolic risk reduction program on diet, activity, and stress, using community-engagement principles. Methods: Applying mixed qualitative and quantitative measures, the intervention had a two-part sequential study design consisting of 12 weekly small group sessions that provided individual and group counseling in nutrition, exercise, and mindfulness, while incorporating focus group and interactive techniques to learn about barriers and acceptable practices for this population. The program was implemented at an African-American church in Nashville, Tennessee. Results: Thirty-four participants (aged 56.1 ± 11 years, body mass index (BMI) 36.7 ± 6.6 kg/m 2 ) completed the intervention. Lifestyle changes after the 12 weekly sessions showed some positive trends including reduced sodium intake (from 2725.3 ± 326.5 to 2132 ± 330, mg/day, P = 0.008), increased walking steps (from 4392.1 ± 497.2 to 4895.3 ± 497.9, steps/day, not significant), and slightly decreased Perceived Stress Scale (PSS) scores (from 13.7 ± 1.4 to 12.4 ± 1.5, not significant). Body fat % among male participants decreased significantly (from 33.8 ± 2.6 to 28 ± 2.6, %, P = 0.043). Among cardiometabolic risk biomarkers, hemoglobin A1c (HbA1c) decreased significantly (from 6.6 ± 0.2 to 976.1 ± 0.2, %, P < 0.001). The baseline PSS score was positively associated with baseline adiposity levels (e.g., weight, β = 2.4, P = 0.006). Twenty-one participants took part in focus groups during the program to identify barriers to healthy lifestyle changes. Primary barriers reported were price, time for preparing healthy meals, unfamiliarity with mindfulness activities, their health condition, and daily schedule available for physical activities. Conclusions: This church-based pilot intervention was proven feasible by showing modest progress in reducing adiposity and decreasing HbA1c levels. The focus group and interactive methods facilitated program direction. Future full-scale studies are warranted to identify key strategies that provide more personalized approaches and supportive environments to sustain a healthy lifestyle among these at risk minorities with limited resources.

Feasibility and Acceptability of the Project Faith Influencing Transformation Intervention in Faith-Based Settings

“…IMPACT: Participants in post-study focus groups reported that: (Brown et al, 2019;Zhou et al, 2017). Focus groups of AA church members following a small pilot study (The Biomedical/Obesity Reduction Trial) identified barriers to dietary change including flavor preferences, cost and time commitment to healthy eating, lack of knowledge regarding recipes or cooking methods, and maintaining motivation (Zhou et al, 2017). Only one study reported on post-study focus groups after a large, multisite diabetes prevention intervention, the Hosea Project (the Hosea Project; Brown et al, 2019).…”

“…Elicitation of qualitative feedback may help address these impact and implementation issues in AA faith-based obesity prevention programs, including Project FIT. However, there are limited qualitative reports on feedback from participants who have engaged in faith-based obesity, physical activity, or dietary interventions to understand how to refine and improve such interventions (Brown et al, 2019; Zhou et al, 2017). Focus groups of AA church members following a small pilot study (The Biomedical/Obesity Reduction Trial) identified barriers to dietary change including flavor preferences, cost and time commitment to healthy eating, lack of knowledge regarding recipes or cooking methods, and maintaining motivation (Zhou et al, 2017).…”

“…However, there are limited qualitative reports on feedback from participants who have engaged in faith-based obesity, physical activity, or dietary interventions to understand how to refine and improve such interventions (Brown et al, 2019; Zhou et al, 2017). Focus groups of AA church members following a small pilot study (The Biomedical/Obesity Reduction Trial) identified barriers to dietary change including flavor preferences, cost and time commitment to healthy eating, lack of knowledge regarding recipes or cooking methods, and maintaining motivation (Zhou et al, 2017). Only one study reported on post-study focus groups after a large, multisite diabetes prevention intervention, the Hosea Project (the Hosea Project; Brown et al, 2019).…”

How Effective Are Mindfulness-Based Interventions for Reducing Stress and Weight? A Systematic Review and Meta-Analysis

“…Moreover, some other studies considered mindfulness, mindful eating, regular exercise, and eating behaviors [26]; reward-based eating [10]; anxiety and depressive symptoms [32]; fasting glucose and blood pressure [33]; depression, sleep quality, regular exercise, and healthy eating [27]; diabetes biomarkers, body measurements, personal satisfaction, diet, and activity measures [34]; barriers and facilitators of healthful eating behaviors, being active, and practicing mindfulness [28]; and depression [35].…”

Strategies for Designing Clergy and Spouse Obesity-Related Programs

“…Underlying most of these conditions are modifiable lifestyle behaviors. Diet quality, 9,10 time spent in physical activity, 11 and stress-reduction 12,13 are all targeted for weight loss and prevention of obesity and obesity-related chronic diseases. While examinations of these health behaviors among clergy are limited, they indicate clergy have difficulty eating healthy, 1 spend little time in moderate-to-vigorous physical activity, 7,14 and report moderate to high levels of occupational stress.…”