Transcript FAITH! Nutrition Education Program

September 2009
FAITH! NUTRITION EDUCATION
PROGRAM
Johns Hopkins School of Public Health and the
New Friendship Baptist Church
Baltimore, Maryland
Supported by the Johns Hopkins Alumni Association and
the Johns Hopkins Urban Health Institute.
FAITH! NUTRITION
EDUCATION PROGRAM
The FAITH! Nutrition Education Program is
theory-based, multi-component health education
intervention program, developed and operated in
partnership with an East Baltimore church.
 The program aims to improve eating habits, as
well as knowledge and beliefs about healthy
eating, among African American adults in order
to raise awareness and potentially prevent
diseases related to dietary choices.

Background: Nutrition and Health

Healthy eating is recognized on global (World Health
Organization, 2003) and national levels (U.S.
Department of Health and Human Services [USDHHS],
2000) as a key component of health living.
Background: Nutrition and Health
Healthy People 2010 Objectives
19-5. Increase the proportion of persons who consume
at least two daily servings of fruit.
 19-6. Increase the proportion of persons who consume
at least three daily servings of vegetables, with at least
one-third being dark green or orange vegetables.
 19-9. Increase the proportion of persons who consume
no more than 30 percent of calories from total fat.
 19-10. Increase the proportion of persons who
consume 2,400 mg or less of sodium daily.

Background: Nutrition and Health
(Not So) Healthy Eating Habits

Despite the general acceptance and widespread
promotion of nutritional health objectives, the
majority of people do not eat enough healthy
foods. In the United States, approximately 25%
of the population reports eating five or more
fruits and vegetables each day (CDC, 2007).
Prevalence data collected by county/city found
that Baltimore City displays lower healthy eating
levels (19.5%) than the Maryland state average
(26.6%; CDC 2007).
Background: Nutrition and Health
(Not So) Healthy Eating Habits
In the U.S., African Americans have lower 5-a-day
fruit and vegetable consumption than whites
(though slightly higher than Hispanics) (CDC, 2007)
 Statewide, in Maryland, these trends for fruit and
vegetable consumption are similar.
 Though specific consumption data by race is not
available for Baltimore City, African Americans
make-up 64.3% of the population (US Census
Bureau, 2006) and citywide data indicates lower
fruit and vegetable consumption than statewide.

Background: Nutrition and Health
(Not So) Healthy Eating Habits

It is important to note that a 2005 CDC report found
that out of all racial/ethnic groups, African
Americans were least likely to report consumption of
5 or more fruit/vegetables each day AND
engagement in regular physical activity.
(http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5613a2.htm#tab)
Background: Nutrition and Health Risks

Poor nutrition is associated with numerous
health risks, including four of the leading causes
of death in the United States - cancer, coronary
heart disease, diabetes, and stroke (USDHHS,
2000).
Background: Nutrition and Health Risks

Higher cancer mortality
rates among African
Americans, when
compared to whites.
Background: Nutrition and Health Risks

Higher cancer mortality
rates among African
Americans, when
compared to whites.
Background: Nutrition and Health Risks

Cardiovascular
disease is the
leading cause
of death among
African
Americans
Background: Nutrition and Health Risks

Hypertension prevalence rates higher among African
Americans
Background: Nutrition and Health Risks
Total prevalence of diabetes in U.S.
o Non-Hispanic Whites: 14.9 million, or 9.8% of all
non-Hispanic whites aged 20 years or older have
diabetes.
o Non-Hispanic Blacks: 3.7 million, or 14.7% of all
non-Hispanic blacks aged 20 years or older have
diabetes.
http://www.diabetes.org/diabetes-statistics/prevalence.jsp
Background: Nutrition and Health Risks


African American
adults are twice as
likely to have a
stroke than whites.
Further, African
American men are
60% more likely to
die from a stroke
than their white
adult counterparts.
http://www.omhrc.gov/templates/content.aspx?ID=3022
Background: Nutrition and Health Risks

African Americans
have a higher
prevalence of
overweight and
obesity, when
compared to whites.
Background: Barriers to Healthy Eating



With numerous health risks connected to poor dietary
practices, such as low fruit and vegetable intake, studies have
examined reasons why African Americans often consume
healthy foods less than other groups.
Barriers include cultural attitudes about dietary choices, low
socioeconomic status, and limited availability of healthy foods
(Baker, Schootman, Barnidge, Kelly, 2006; Morland, Wing,
Diez Roux, Poole, 2002; Watters, Satia, Galanko, 2007).
Other factors may include traditional cooking/preparation
techniques, and beliefs that healthy foods are too expensive,
overly time-consuming in preparation, or do not taste as good
as healthier foods (CDPH, 2007).
Background: Church-Based Health Programs



Numerous studies have identified the benefits of churchbased health promotion programs for African Americans
(Campbell, Hudson, Resnicow, Blakeney, Paxton, Baskin,
2007).
The majority of African Americans in the U.S. identify
themselves as religious (Kosmin, Mayer, and Keysar,
2006), and church is often recognized as a key aspect of
cultural, social and political life for African Americans
(Campbell et al, 2007).
Many churches include health ministries, or provide some
type of group or leadership support related to healthy
living (Lasater, Becker, Hill, Gans, 1997).
Background: Church-Based Health Programs


Partnership with churches has become an essential
component in reducing health disparities among African
Americans, who in some cases may not seek and receive
health care through traditional channels (Campbell, 2007;
Eng, Hatch, and Callan, 1985).
Also, churches often provide a stable environment in terms
of participant recruitment (Campbell et al, 2007).
Background: Multi-component programs

•
•
•
Our program was informed by other multi-component
church-based programs, such as:
Black Churches United for Better Health (BCUBH) project
(Campbell et al., 1999; Campbell et al., 2000);
Eat for Life study (Resnicow et al., 2001).
And the culmination of these projects, the Body and Soul
Program, a partnership of the National Cancer Institute,
the American Cancer Society, and the Centers for Disease
Control and Prevention. (http://bodyandsoul.nih.gov/)
FAITH! Nutrition Education
Program
The FAITH! Nutrition Education Program is
theory-based, multi-component health education
intervention program, developed and operated in
partnership with an East Baltimore church.
 The program aims to improve eating habits, as
well as knowledge and beliefs about healthy
eating, among African American adults in order
to raise awareness and prevent diseases related
to dietary choices.

FAITH! Nutrition Education
Program
The FAITH! Nutrition Education Program aimed
to accomplished its goals through two interactive
educational sessions held at the church.
 The sessions included multiple components for
presenting information on healthy eating and
disease prevention, such lectures, educational
materials, and cooking demonstrations.

FAITH! Strategic Design


The PRECEDE-PROCEDE Model was used to
strategically inform the theoretical design of the
program.
Based on literature review, the social and
epidemiological assessments determined poor
dietary intake as a health problem that impacts
quality of life through chronic diseases related to
diet. (These findings were later supported in
focus group meeting.)
Phases 5
Phase 4
Administration
& Policy
Assessment
Education &
Ecological
Assessment
PROGRAM
COMPONENTS
Church-based
Seminars;
Educational
Materials;
Healthy Snack
display;
Cooking
demonstrations;
Involvement of Church
Leadership and
members
PRECEDE
Phase 3
Behavioral &
Environmental
Assessment
Phase 2
Phase 1
Epidemiological
Assessment
Social
Assessment
Predisposing Factors:
lack of knowledge about
nutrition;
negative beliefs about
barriers/sustainability of
diet change
Education about
importance of food
choice
Reinforcing Factors:
peer influence;
social support in church;
vicarious reinforcement
via pastor
Availability to buy/cook
nutritious foods
Higher rates
of chronic
disease
and cancer
Lack of
healthy food
consumption
Snack choices available
at church gatherings
Enabling Factors:
motivational tools;
cooking skills
Support for nutritious eating
in church and at home
PROCEED
Phase 8
Phase 6
Phase 7
Implementation
Process Evaluation
Impact Evaluation
Phase 9
Outcome Evaluation
PROCEED
-ability to
implement
program as
planned
-adequate
budget for
staff and
resources
-support
from church
leaders
and key
personnel
-training
and
supervision
for all staff
Phase 6
Implementation
-participant
evaluation
of seminars
and overall
program
-comment
cards at the
Healthy
Snack Area
-regular
contact with
church
pastor and
members
Phase 7
Process Evaluation
-Fruit and
Fat
screener
at baseline
and end of
program
-Health
Beliefs
Questionnaire at
baseline
and end of
program
-baseline
health
status
information
Phase 8
Impact Evaluation
-Fruit and
Fat
screener at
6 month
follow-up
-Health
Beliefs
Questionnaire at 6
month
follow-up
-health
status
information
at 6-month
follow-up
Phase 9
Outcome Evaluation
Development and Planning
o Developed as a project in Dr. Gielen’s
Fundamentals of Health Promotion and Health
Education course at JHSPH in Fall 2007
o Program received funding from the JHU Alumni
Association and Johns Hopkins Urban Health
Institute in early 2008
Development and Planning
oFrom the receipt of funding in early 2008
to our first focus group meeting, twicemonthly investigator planning meetings
were held to develop the key aspects of the
program for implementation.
oThis development process included the
creation of the agendas for the educational
sessions, and the identification and/or
creation of the educational and evaluative
materials, the video presentations, the
cooking demonstrations and food samples,
and the lecture topics and speakers. Also,
IRB approval was sought and granted
during planning.
Partnership with a Local Church
Of key importance for the FAITH! program,
planning meetings involved discussions on how to
identify and partner with an East Baltimore
church.
 We wanted to work with a church located in close
proximity to Johns Hopkins Medical Institutions.
Churches were researched through Internet and
phone book searches, and several areas churches
were contacted.

Partnership With A Local Church
o The New Friendship Baptist Church was
one of the identified churches; it was
prioritized in our search due to its close
proximity to the Johns Hopkins Medical
Campus, and because one of our program
investigators has previous knowledge of the
church through a family member.
o We met with New Friendship Pastor
Michael Palmer to discuss the proposed
program and to determine whether he felt it
would benefit his congregation.
o The meeting resulted in an agreement that
the FAITH! program would be of interest
and benefit to the New Friendship
congregation.
Partnership With A Local Church
o The FAITH! program partners with the
New Friendship Baptist Church in East
Baltimore to hold educational events related
to healthy eating and disease prevention.
The church is located just blocks from the
Johns Hopkins School of Public Health and
Johns Hopkins Hospital.
o The church, led by Pastor Michael Palmer,
is instrumental in program development,
and provides space and event promotion for
the FAITH! Program.
Focus Group
o We held a focus group meeting with members of
the New Baptist Friendship Church to discuss the
FAITH! program and to receive feedback and
suggestions.
o Participants heard an overview of the proposed
program and its goals. The meeting included a
guided discussion on healthy eating, diseases related
to diet, and barriers to eating healthy foods. The
group was presented copies of the proposed
educational and evaluation materials for their
review and feedback, and a video example of a
similar church-based health program was shown.
Program Refinement
o Following the focus group meeting, the program investigators
reviewed and revised the program materials according to the
participant recommendations.
o In particular, lectures on diabetes and diabetes management
were scheduled for the first educational session; a question
about family history of disease was added to the demographic
questionnaire; a slide presentation was designed to guide
participants during the completion of evaluation materials; and
supermarket gift cards were purchased for program participants.
FAITH! Program Components

o
o
o
o
o
o
The main program components include:
educational sessions and materials (manuals and
cookbooks)
lectures on healthy eating and diseases related to
diet
video presentations on healthy eating
healthy cooking demonstrations and food samples
evaluation of nutrition-related beliefs and food
intake among participants
the establishment of a health pantry
Promotion
oThe focus group members,
along with Pastor Palmer,
agreed that the church would
assist with promotion of the
FAITH! program
o Event information was
included in the weekly church
bulletin, and flyers were
posted in the lobby.
Kick-Off Event
In mid-May, we held a kick-off
event at the church to announce
the program and to provide
information about the educational
and research activities involved.
Over 50 church members
attended this kick-off event.
Educational Session #1
o On June 21, we held the first
educational session, which included:
• two educational lectures, one by a
registered nurse from JHU on diabetes
control and one by a medical doctor from
JHU on diabetes complications;
• a video presentation, Forgotten
Miracles, a CDC-developed video on
health eating;
• a healthy cooking demonstration by a
local Baltimore chef, followed by a
healthy lunch.
o About 35 members from the church
attended, and each person was given an
educational manual, as well as a
healthy food cookbook.
Educational Session #2
o On July 19, we held the second
educational session, which included:
• two educational lectures, one by a
registered nurse from JHU on
hypertension and one by a medical
doctor from JHU on kidney disease;
• a video presentation, A Day in The
Life, a video on health eating and
lifestyle choices;
• a prepared healthy lunch (low-fat, lowsodium)
• a planning session for continuation of
the program and healthy eating
activities at the church
o About 25 church members attended,
and each person was given a
supplemental education manual.
Evaluation
o The program investigators collected four
evaluation forms from participants:
1) a demographic and health background
questionnaire (designed by our program and
informed by focus group members);
2) a health beliefs and attitudes
questionnaire (designed by our program and
based on the Health Belief Model, Social
Cognitive Theory and Community
Mobilization constructs);
3) food frequency survey for fat intake and
fruit/vegetable/fiber intake (intake surveys
designed by Gladys Block and colleagues; see
Block, Gillespie, Rosenbaum, Jenson, 2000);
4) a satisfaction survey at the end of each
session.
Evaluation
27 participants completed the
baseline research evaluation forms at
the 1st session. 22 participants
completed the follow-up evaluation
forms at program completion. A sixmonth follow-up was held and 25
participants completed forms.
o
o Satisfaction surveys were collected
at all sessions to date. The majority of
participants rated the program as
“excellent” and indicated that they
would attend future sessions.
Evaluation
Based on evaluations, we looked at
attitudinal and behavioral changes over
six months for participants who attended
at least one session and completed the
six month forms (N=23).
o
o Summary statistics:
-Mean age = 50 (min 23 and max 83)
-74% female
Initial Findings: Eating Habits
17% of participants were eating 5 or
more FV at baseline; this increased to
nearly 40% at six months
o
o Fiber intake displayed a small
increase from 13 grams per day to
over 14 grams per day.
o Those whose fat daily fat intake
was less than 30% of total daily diet
increased from 30% to 45% of all
participants at six months
Initial Findings: Attitudes
At six months, all participants said
that they felt they would able to eat
healthy foods on a regular basis (selfefficacy; 10% increase from baseline)
o
o Also, we saw measurable
improvement in the % of persons who
identified the severity of diseases
related to poor nutrition
o We did not find a significant change
in the number of participants who
discussed diet with their physician or
care provider
Pantry Planning
Following the educational sessions, we held a focus
group to discuss the development of a healthy food
pantry at the church. Potential foods, design and
operation, sustainability and barriers were discussed
in terms of establishing a pantry.
o
o We also created a survey, which was distributed
during Sunday service with Pastor Palmer’s direction,
to members of the congregation to assess interest,
frequency of operation and whether any members
would like to help run the pantry.
Pantry Development and Opening
o Through
planning activities and with Pastor Palmer’s
help, we worked with an interested church member to
bring the pantry to fruition. We partnered during
Spring 2009 to brainstorm on operation logistics and to
select healthy food and drink items. The FAITH!
Program purchased a pantry cart and provided some
funds to initially stock the pantry.
o Thanks to the hard work of
Ms. Matthews, the FAITH! Pantry
had a very successful opening on
Sunday, July 26, 2009!
Limitations
o No control group, and relatively small sample size
o Use of self-report measures for dietary intake and
health status questions.
o Would like to involve and integrate church
leadership and members earlier in the development
process; want to have church member serve in
training and advisory roles within the program.
o Did not evaluate the program materials for health
literacy levels.
Ongoing Efforts and Future Plans
o Further analysis and interpretation of collected
health status, health belief, and dietary intake data
o Manuscript submitted to Health Promotion
Practice, with Pastor Palmer as a co-author
o Abstract accepted to the APHA annual meeting,
where we will present a poster on the program
o Continued partnership with New Friendship and
Pastor Palmer to help the pantry grow and support
future health initiatives
o Expansion of program to other churches in East
Baltimore; currently seeking funding opportunities
Thanks!
o Many thanks to our sponsors:
The Johns Hopkins Alumni Association
and The Johns Hopkins Urban Health
Institute.
o Thanks to the New Friendship Baptist
Church, Pastor Michael Palmer, Dr.
Andrea Gielen, Dr. Janice Bowie, Nurse
Jeanne Charleston, Dr. Carlos Williams,
and Dr. Deidra Crews.
The Johns Hopkins University Alumni Association
Dr. Carlos Williams, Chef Rodney Madison and
Pastor Michael Palmer (from left to right)
FAITH! team members: Brian Buta, LaPrincess
Brewer and Deneen Hamlin (from left to right)