Healthy living is critical to prevention of chronic diseases. Previous research has shown multilevel public health intervention programs to be the most effective strategy for promoting health, as these programs offer individual, community, and structural opportunities for healthy behaviors. Existing evidence based physical activity and healthy eating interventions have shown improvements in physical activity and consumption of fruits and vegetables, but only with community and structural interventions have the increases in activity and healthy eating been sustained well-after the intervention was complete. Economically deprived communities suffer from an absence of both environmental and person-level resources, including food shortages and limited safe recreational space, to support healthy living behaviors, including physical activity and healthy eating. The Church Challenge is a physical activity and diet intervention that was developed by Flint-area churchgoers and the Genesee County Health Department in response to concerns about parishioners? fitness and weight. It is a two- level (church and individual) level intervention to help kick-start congregant physical activity and dietary changes. At the church level, churches facilitate: (1) three history lessons on why African-Americans have the dietary patterns that they do and information on how these patterns can be adjusted to be healthier; (2) healthy cooking classes; (3) church social and peer support in the form of regular announcements and groups within each church who compete in a church-based weight loss challenge; and (4) access to a local church-based food pantry. In addition, the program incorporates scripture and other spiritual principles (it was developed primarily by pastors). At the individual level, individuals commit to (1) attending the healthy cooking classes and historical lessons, and (2) select, publicly commit to, and attend 3 specific aerobics classes weekly at a local church-affiliated fitness center. The proposed project will add and assess the effects of a third, community level, intervention: engaging participating churches in policy advocacy and private sector communications to improve healthy land use in Flint (e.g., by reintroducing a large scale grocery market to the city of Flint, providing sidewalks, bike lanes, and other safe places for physical activity that do not require cars for residents to access). We will examine how the third level intervention increases churches? capacity for and participation in community advocacy around policy issues. We are not aware of another faith-involved intervention RCT that has involved a community-policy level, or that has used churches to drive change at that policy level. This project will (1) examine the effectiveness of a community-designed, community-based, multilevel physical activity and diet intervention (the Church Challenge) relative to enhanced treatment as usual among 770 people in 30 primarily African-American Flint- area churches using a randomized controlled trial (RCT) design, randomized by church; (2) conduct longitudinal and process evaluations of promoting church engagement in policy advocacy to improve health land use in Flint; and (3) evaluate church-level and individual-level sustainment of behavior change.
|Sadler, Richard C; Hippensteel, Christopher; Nelson, Victoria et al. (2018) Community-engaged development of a GIS-based healthfulness index to shape health equity solutions. Soc Sci Med :|