The Faith, Activity, and Nutrition Program

Abstract

Background Faith-based interventions hold promise for promoting health in ethnic minority populations. To date, however, few of these interventions have used a community-based participatory research (CBPR) approach, have targeted both physical activity and healthy eating, and have focused on structural changes in the church. Purpose To report the results of a group randomized CBPR intervention targeting physical activity and healthy eating in African-American churches. Design Group RCT. Data were collected from 2007 to 2011. Statistical analyses were conducted in 2012. Setting/participants Seventy-four African Methodist Episcopal (AME) churches in South Carolina and 1257 members within them participated in the study. Intervention Churches were randomized to an immediate (intervention) or delayed (control) 15-month intervention that targeted organizational and environmental changes consistent with the structural ecologic model. A CBPR approach guided intervention development. Intervention churches attended a full-day committee training and a full-day cook training. They also received a stipend and 15 months of mailings and technical assistance calls to support intervention implementation. Main outcome measures Primary outcomes were self-reported moderate-to-vigorous-intensity physical activity (MVPA), self-reported fruit and vegetable consumption, and measured blood pressure. Secondary outcomes were self-reported fat- and fiber-related behaviors. Measurements were taken at baseline and 15 months. Intent-to-treat repeated measures ANOVA tested group X time interactions, controlling for church clustering, wave, and size, and participant age, gender, and education. Post hoc ANCOVAs were conducted with measurement completers. Results There was a significant effect favoring the intervention group in self-reported leisure-time MVPA (d=0.18, p=0.02), but no effect for other outcomes. ANCOVA analyses showed an intervention effect for self-reported leisure-time MVPA (d=0.17, p=0.03) and self-reported fruit and vegetable consumption (d=0.17, p=0.03). Trainings were evaluated very positively (training evaluation item means of 4.2–4.8 on a 5-point scale). Conclusions This faith-based structural intervention using a CBPR framework showed small but significant increases in self-reported leisure-time MVPA. This program has potential for broad-based dissemination and reach. Trial registration This study is registered at www.clinicaltrials.gov NCT00379925.

Process evaluation methods, implementation fidelity results and relationship to physical activity and healthy eating in the Faith, Activity, and Nutrition (FAN) study

“…During the first year of the project, a planning committee that included church leaders, lay church members, and university faculty and staff met monthly to plan the intervention and evaluation and met quarterly to oversee study activities in subsequent years. As described in detail elsewhere (Wilcox et al, 2010, 2013), 128 churches from four AME districts in South Carolina were invited to participate in this group randomized trial and 74 of these enrolled. Churches were located in both rural and more populated areas, and 26 were considered small in size (<100 members), 44 medium (100–500 members), and 12 large (>500 members).…”

“…All items were rated on four-point scales and church-level means were calculated to reflect level of implementation (higher score = greater implementation). Detailed design and methods for administering congregant surveys have previously been reported (Wilcox et al, 2013). In summary, participants were recruited by church liaisons to take part in a measurement session.…”

“…The primary study outcomes, measured at baseline and 15- months later (post-intervention for intervention churches) were congregant self-reported physical activity and fruit and vegetable consumption described in more detail below (see Wilcox et al, 2010, 2013). …”

“… Adapted from Wilcox et al (2010). Note: Highlighted measures used in mediation analyses. Shaded portion depicts project elements evaluated with process evaluation.…”

“…Participants in intervention compared to control churches showed modest but significantly larger increases in self-reported leisure-time physical activity and fruit and vegetable consumption in a group randomized trial (Wilcox et al, 2013). Unique elements of FAN included a community-based participatory research (CBPR) approach in a faith-based setting with extensive stakeholder involvement from prefunding through the dissemination phases of the project; a flexible and adaptive intervention that emphasized integrating healthful eating and physical activity into organizational (church) routines; and a public health focus on changing the church physical and social environment to achieve population behavior change (Wilcox et al, 2010, 2013). Given the complexity of the setting and intervention approach, a comprehensive approach to process evaluation was an integral part of the FAN project.…”