PARTNERS FOR HEALTHY LIFESTYLES

1. Working Today For A Healthier Tomorrow Piedmont Health District PARTNERS FOR HEALTHY LIFESTYLES Barbara Jackson-Marshall RN, MPH, CHES Assistant Director For Prevention Programs Tim Powell, MPH Mark Levine, MD, MPH Epidemiologist District Health Director Piedmont Health District/Virginia Department of Health Farmville, VA

2. VIRGINIA & PIEDMONT HEALTH DISTRICT

3. PIEDMONTDEMOGRAPHICS • Seven counties, of approximately 2830 square miles, with a total population of 97,103. • 34.3 persons per square mile. • 36 percent of Piedmont residents are African American, and 2 percent are of other non-white race. • Average median household income for the district is $31,563. • 17.2 percent of residents live below the poverty level. • Unemployment rate of 4.7 in 2002. • All 7 counties listed as Medically Underserved Areas, 5 as Healthcare Provider Shortage Areas.

4. Demographics Cont. • 30.1 percent of Piedmont residents suffer from obesity, an estimated 22,592 persons. • 8.6 percent of Piedmont adults suffer from diagnosed diabetes, an estimated 6,455 persons.

5. RATIONALE • CVD is a significant public health concern in our rural health community. • Compared to the state and nation, these residents are more likely to be poor, African American, and have difficulty accessing medical care. • African-Americans in Piedmont are significantly more likely than whites to be overweight, poor, and have sedentary lifestyles. • African-Americans have higher rates of mortality from chronic diseases, particularly cardiovascular disease.

6. RATIONALE • The health disparities are wider than that of Virginia and the United States. • The Church serves as both the principal meeting area and key motivator for change amongst Piedmont’s African-American adult population.

7. PARTNERS FOR HEALTHY LIFESTYLES 2000 The District investigated whether a faith-based intervention could reduce cardiovascular risk factors.

8. GOAL:INCREASE HEALTHY YEARS OF LIFE OBJECTIVE: To educate and support participants to change, improve and maintain healthy behaviors by reducing fat intake and increasing physical activity to 3 days a week for at least 20 minutes a day. *Note: This has changed to 5 days a week for at least 30 minutes a day.

9. METHOD • Phase I - Introduction • Form partnerships with African American churches within the health district. • Churches were recruited to participate in the PHL program. • Selected and trained volunteer Lay Health Workers (LHW) to facilitate the church meetings and assist with collecting data, monitoring progress, and serve as the “motivator”. • Participants enrolled and frequency and dates for meeting times established. • Establish Buddy system. • Baseline data collected and self reported medical history taken.

10. INDICATORS • Church participation ( minimum of 12 participants) – family is encouraged to attend • Body Mass Index • Waist circumference • Dietary fat intake - self report form • Physical activity level – self report log

11. METHOD • Phase II - Education intervention on Cardio-vascular Risk factors • Nutrition – “Managing Soul Food” • “Praisercise” – engage participants in physical activity and walking to gospel music • Gospel Aerobics” soft aerobics at weekly meetings • Attempted to overcome cultural dietary and exercise norms • Other Risk factors – Hypertension, Cholesterol, Diabetes

12. Phase II continued • Subject chosen by participants • Sharing Activity - Engaged the participants into a “mind set” that CVD is a significant health issue and that its effects are modifiable. • Introduced to monitoring/tracking logs for physical activity, dietary fat intake and Personal Commitment Goal • Incentives were used as motivators for successes at intervals and for completion of the program.

13. METHOD • Phase III - Maintenance Period • Participants record their dietary fat intake and physical activity weekly • LHW collects data, supports and motivates participants to decrease fat intake and increase physical activity • District program manager and part time program coordinator worked with the LHW

14. Change In Cardiovascular RisksBMI, PHD 2000

15. Change in Cardiovascular RisksWaist (inches), PHD 2000

16. Change In Cardiovascular RisksDietary fat (%calories), PHD 2000

17. Change In Cardiovascular RisksExercise (> 20 minutes/day,3 days/week), PHD 2000

18. FY 2000 Church Locations

19. FY 2000-2003 Church Locations

20. BARRIERS/CHALLENGES • Isolation • Small church congregations • Lack of Interest • Difficulty conceptualizing the relationship between church and personal health • Establishing trust and credibility • Rural setting – lack of public transportation • Collaboration among churches was complicated • Pastors do not live in the community. The Pastor may minister more than one church. • Sustainability – LHW were trained to continue the program the following year. Pastors supported continuing the program.

21. Practices that created a spiritual basis, spiritual support, spiritual guidance, fellow encouragement, and helped participants accept, but into, and perceive long term changes to improve personal/family health behaviors. • Courtship” with churches during the months of June – August. • District and the Church identified scriptures that connected the principles of the program to the individual church doctrine. • “M & M Break” “Motivation & Meditation Break” - “affirmation” of good health and healthy body which stemmed from one of the scriptures. • “ Prayer Partner” – support person

22. LESSONS LEARNED • Importance of meeting people “where they are”. • Listen - Enter the individual church with the approach of “how can I help you” and paying attention to the health/needs of the individual congregation. • Get the Pastor’s sanction and members want him and/or his wife actively involved in the program. • Operate within the culture and practices of each individual church/faith-based organization. • Establish trust and credibility • Don’t promise something that you can’t deliver. • Open and honest communication.

23. SUSTAINABILITY • LHW were trained to continue the program the following year. Pastors supported continuing the program • Overcome funding decreases by expanding the partnerships to local organizations to promote centralized locations. • Work with local schools and fitness centers to provide community opportunity for physical activity • Get community support to expand the program, get a champion and/or advocates for the program • Seek other grant funding

24. Keys To Success As Reported by the Focus Group • Belief in the methods • Belief in the connection between health and religion • Good health is determined by behavior change and consistency • The body is sacred; take care of it through good nutrition and eating habits • Monitoring food intake is more important that dieting (fads) • Weight control and exercising/physical activity require persistence and consistency • The PHL program can result in life long or long term outcomes • Healthy bodies come in all sizes

25. CONCLUSION FAITH- BASED INTERVENTIONS ARE A COMPELLING AND POWERFUL FORCE OF LIFESTYLE BEHAVIOR CHANGE IN RURAL AFRICAN-AMERICAN COMMUNITIES