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In this pilot study, we tested a virtual family strengthening and mental health promotion intervention, Coping Together (CT), during the COVID-19 pandemic. We explored changes at the family and individual levels, as well as mechanisms of change. Participants included 18 families (24 caregivers, 24 youth) with children aged 7 to 18 years. Community health workers delivered the 8-session CT intervention using videoconferencing software. We used qualitative semi-structured interviews with 14 of the families to explore changes and mechanisms of change using a thematic content analysis approach. We also administered pre-post surveys with the 18 families to explore the direction of changes, using only descriptive statistics in this small sample. Qualitative findings supported positive changes across family and individual level outcomes including family functioning, relationship quality, and individual psychosocial well-being. Results also confirmed several hypothesized mechanisms of change with improved communication providing the foundation for increased hope and improved problem solving and coping. Pre-post survey results were mixed, showing positive, but very small, changes in family closeness, caregiver-child communication, and levels of hope; almost no change was observed on measures of caregiver and child mental health. Families reported few problems at baseline quantitatively despite qualitative descriptions of pre-intervention difficulties. Results provide preliminary support for benefits of CT with the most consistent improvements seen across family relationships. Findings were mixed related to individual-level mental health benefits. Results have implications for revising content on mental health coping strategies and suggest the need to revise the quantitative measurement strategy for this non-clinical sample. [ABSTRACT FROM AUTHOR]

Maintaining healthy behaviors is challenging. Based upon previous reports that in North Carolina (NC), USA, overweight/obese clergy lost weight during a two-year religiously tailored health intervention, we described trajectories of diet, physical activity, and sleep. We investigated whether behavior changes were associated with weight and use of health-promoting theological messages. Improvements were observed in sleep, calorie-dense food intake, and physical activity, with the latter two associated with weight loss. While theological messages were well-retained, their relationship with behaviors depended on the specific message, behavior, and timing. Findings offer insights into weight loss mechanisms, including the role of theological messages in religiously tailored health interventions. [ABSTRACT FROM AUTHOR]

COVID-19 led to widespread disruption of services that promote family well-being. Families impacted most were those already experiencing disparities due to structural and systemic barriers. Existing support systems faded into the background as families became more isolated. New approaches were needed to deliver evidence-based, low-cost interventions to reach families within communities. We adapted a family strengthening intervention developed in Kenya ("Tuko Pamoja") for the United States. We tested a three-phase participatory adaptation process. In phase 1, we conducted community focus groups including 11 organizations to identify needs and a community partner. In phase 2, the academic-community partner team collaboratively adapted the intervention. We held a development workshop and trained community health workers to deliver the program using an accelerated process combining training, feedback, and iterative revisions. In phase 3, we piloted Coping Together with 18 families, collecting feedback through session-specific surveys and participant focus groups. Community focus groups confirmed that concepts from Tuko Pamoja were relevant, and adaptation resulted in a contextualized intervention—"Coping Together"—an 8-session virtual program for multiple families. As in Tuko Pamoja, communication skills are central and applied for developing family values, visions, and goals. Problem-solving and coping skills then equip families to reach goals, while positive emotion-focused activities promote openness to change. Sessions are interactive, emphasizing skills practice. Participants reported high acceptability and appropriateness, and focus groups suggested that most content was understood and applied in ways consistent with the theory of change. The accelerated reciprocal adaptation process and intervention could apply across resource-constrained settings. [ABSTRACT FROM AUTHOR]

The job–demand–control–support model indicates that clergy are at high risk for chronic stress and adverse health outcomes. A multi-group pre-test–post-test design was used to evaluate the feasibility, acceptability, and range of outcome effect sizes for four potentially stress-reducing interventions: stress inoculation training, mindfulness-based stress reduction (MBSR), the Daily Examen, and Centering Prayer. All United Methodist clergy in North Carolina were eligible and recruited via email to attend their preferred intervention. Surveys at 0, 3, and 12 weeks assessed symptoms of stress, anxiety, and perceived stress reactivity. Heart rate variability (HRV) was assessed at baseline and 12 weeks using 24 h ambulatory heart rate monitoring data. A subset of participants completed in-depth interviews and reported skill practice using daily text messages. Standardized mean differences with 95% and 75% confidence intervals were calculated for the change observed in each intervention from baseline to 3 and 12 weeks post-baseline to determine the range of effect sizes likely to be observed in a definitive trial. 71 clergy participated in an intervention. The daily percentage of participants engaging in stress management practices ranged from 47% (MBSR) to 69% (Examen). Results suggest that participation in Daily Examen, stress inoculation, or MBSR interventions could plausibly result in improvement in stress and anxiety at 12 weeks with small-to-large effect sizes. Small effect sizes on change in HRV were plausible for MBSR and Centering Prayer from baseline to 12 weeks. All four interventions were feasible and acceptable, although Centering Prayer had lower enrollment and mixed results. [ABSTRACT FROM AUTHOR]

Clergy are tasked with multiple interpersonal administrative, organizational, and religious responsibilities, such as preaching, teaching, counseling, administering sacraments, developing lay leader skills, and providing leadership and vision for the congregation and community. The high expectations and demands placed on them put them at an increased risk for mental distress such as depression and anxiety. Little is known about whether and how clergy, helpers themselves, receive care when they experience mental distress. All active United Methodist Church (UMC) clergy in North Carolina were recruited to take a survey in 2019 comprising validated depression and anxiety screeners and questions about mental health service utilization. Bivariate and Poisson regression analyses were conducted on the subset of participants with elevated depressive and anxiety symptoms to determine the extent of mental health service use during four different timeframes and the relationship between service use and sociodemographic variables. A total of 1,489 clergy participated. Of the 222 (15%) who had elevated anxiety or depressive symptoms or both, 49.1% had not ever or recently (in the past two years) seen a mental health professional. Participants were more likely to report using services currently or recently (in the past two years) if they were younger, had depression before age 21, or "very often" felt loved and cared for by their congregation. The rate of mental health service use among UMC clergy is comparable to the national average of service use by US adults with mental distress. However, it is concerning that 49% of clergy with elevated symptoms were not engaged in care. This study points to clergy subgroups to target for an increase in mental health service use. Strategies to support clergy and minimize mental health stigma are needed. [ABSTRACT FROM AUTHOR]

As an occupational group, clergy exhibit numerous physical health problems. Given the physical health problems faced by clergy, understanding where physical health falls within the priorities of seminary students, the ways students conceptualize physical health, and how seminary students do or do not attend to their physical health in the years immediately prior to becoming clergy, can inform intervention development for both seminary students and clergy. Moreover, understanding and shaping the health practices of aspiring clergy may be particularly impactful, with cascading effects, as clergy serve as important role models for their congregants. Drawing on 36 in-depth, qualitative interviews with first-year seminary students, this study examines the complex dynamics between religious frameworks related to physical health, explicit intentions to maintain healthy practices, and reported physical health behaviors. Our findings suggest that even students who deploy religious frameworks in relation to their physical health—and who, as a result, possess positive intentions to implement and maintain healthy behaviors—often report being unable to live up to their aspirations, especially in the face of barriers to health practices posed by the seminary program itself. After reviewing these findings, we offer suggestions for physical health focused interventions, including action and coping planning, which could be implemented at seminaries to reduce the intention–behavior gap and improve clergy health. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic hepatitis C and risky/harmful alcohol use experience poor outcomes. Granular data evaluating whether alcohol counseling during hepatitis C treatment impacts longitudinal alcohol consumption are lacking. Aims: To evaluate whether provider-delivered counseling in the context of direct-acting antiviral hepatitis C treatment associates with decreased longitudinal alcohol consumption. Methods: We performed secondary data analysis from the Hep ART study including adults with hepatitis C who underwent provider-delivered counseling during direct-acting antiviral treatment between October 2014 and September 2017. Demographics and disease characteristics were summarized. Alcohol consumption, abstinence, and heavy drinking were evaluated in periods before, during, and after direct-acting antiviral treatment. Multivariate regression analyses were performed to evaluate the association of alcohol consumption with each 12-week time period for all patients and a subsample with cirrhosis. Results: One hundred twenty-three patients were included; 41 had cirrhosis. Most patients were male (74.0%) and Black (58.5%). Alcohol consumption improved during direct-acting antiviral treatment and was notably sustained (< 12 weeks before treatment 32.5 g/day; during treatment 20.0 g/day; and 12–24 weeks after treatment 23.7 g/day). Multivariable analyses showed significantly improved alcohol consumption metrics during and after antiviral treatment compared to < 12 weeks before treatment (during treatment 13.04 g/day less, p = 0.0001; > 24 weeks after treatment 15.29 g/day less, p = 0.0001). The subsample with cirrhosis showed similar results (during treatment 13.21 g/day less, p = 0.0001; > 24 weeks after treatment 7.69 g/day less, p = 0.0001). Conclusions: Patients with chronic HCV and risky/harmful alcohol use given provider-delivered alcohol-related counseling during HCV treatment sustain decreased alcohol consumption patterns during and after treatment. [ABSTRACT FROM AUTHOR]

The researcher-driven conceptualizations of mental health that undergird flourishing measures have not been extensively studied qualitatively for acceptance by people in low and middle income countries. We conducted in-depth interviews with caregivers of orphaned and separated children (OSC) in five geographic regions (Kenya; Ethiopia; Cambodia; Hyderabad, India; and Nagaland, India). Sixty-two participants answered open-ended questions including, "What does mental health mean to you? What does it mean to be mentally healthy?" We coded responses using a priori and data-driven codes and analyzed coded text for themes. Across regions, participants frequently articulated similar conceptualizations, which did not include orientations/values but spanned experiences, functioning, and behaviors, as well as the eudaimonic and hedonic traditions of happiness. Functioning included good states of mind (peaceful mind, thinking clearly, thinking positively) and being physically healthy. Behaviors were contributing to the community and spending enjoyable time in groups. For experiences, participants universally indicated happiness, which was the most prominent feature of good mental health, using terms such as "happy," "jovial," and "joy." Across all geographic regions, mental health was not articulated merely as the absence of mental illness. A two continua model of good mental health emerged spontaneously among half of Kenyan and one-third of Cambodian participants. Altogether, the lay conception of 'a person who is mentally healthy' across these diverse non-western cultures supports multiple existing conceptions and measurements of flourishing. Researchers may consider adding to their conceptualizations good functioning in the form of clear and peaceful thinking and the behavior of enjoyable socializing. [ABSTRACT FROM AUTHOR]

Studies of caregivers of orphans and vulnerable children (OVC) rarely examine the role religion plays in their lives. We conducted qualitative interviews of 69 caregivers in four countries: Ethiopia, Kenya, Cambodia, and India (Hyderabad and Nagaland), and across four religious traditions: Christian (Orthodox, Roman Catholic, and Protestant), Muslim, Buddhist, and Hindu. We asked respondents to describe the importance of religion for their becoming a caregiver, the way in which religion has helped them make sense of why children are orphans, and how religion helps them face the challenges of their occupation. Using qualitative descriptive analysis, three major themes emerged. Respondents discussed how religion provided a strong motivation for their work, reported that religious institutions were often the way in which they were introduced to caregiving as an occupation, and spoke of the ways religious practices sustain them in their work. They rarely advanced religion as an explanation for why OVC exist—only when pressed did they offer explicitly religious accounts. This study has implications for OVC care, including the importance of engaging religious institutions to support caregivers, the significance of attending to local religious context, and the vital need for research outside of Christian contexts. [ABSTRACT FROM AUTHOR]

Keeping the Sabbath, that is, setting a day apart for rest and spiritual rejuvenation, has been related to better mental health and less stress in cross-sectional studies. However, for clergy, keeping Sabbath can be complicated by needing to work on Sundays and the round-the-clock nature of clergy work. Nevertheless, numerous studies demonstrating high depression rates in clergy populations suggest clergy need to attend to their mental health. Religious denomination officials interested in preventing depression in clergy may be tempted to recommend Sabbath-keeping, although recommending other forms of rest and rejuvenation, including connecting with others, is also possible. This study examined the relationships of Sabbath-keeping as well as multiple other forms of rest and rejuvenation (vacation, sleep, relaxing activities, and social support) to mental and physical health and spiritual well-being using survey data from 1316 United Methodist clergy. Appropriate regression analyses (logistic, linear, and Poisson) were used to determine which clergy were more likely to keep the Sabbath and examined the relationships between Sabbath-keeping and multiple well-being outcomes. Receiving more social support was strongly associated with Sabbath-keeping. Sabbath-keeping was not significantly related to mental or physical health, after adjusting for covariates such as social support, although Sabbath-keeping was significantly related to higher quality of life and spiritual well-being—the original purpose of Sabbath-keeping—in clergy. To adequately test whether Sabbath-keeping could promote mental health for clergy beyond other forms of rejuvenation, intervention studies are needed. [ABSTRACT FROM AUTHOR]

HIV prevention interventions are generally effective at reducing sexual risk. Although these interventions have been widely disseminated in the USA, their success depends largely on whether subpopulations who have been prioritized for risk reduction are willing to participate. Understanding the factors predicting service utilization is critical to maximizing public health benefit. HIV-negative men who have sex with men (MSM) (n = 613) were enrolled in a longitudinal study investigating whether theoretically derived psychosocial variables (past behavior, cues to action, perceived susceptibility, positive expectations, perceived barriers, personal discomfort, and recent condomless anal intercourse) predicted intentions to use HIV prevention services and service use behavior across multiple categories (information seeking, structured service use, HIV testing, and volunteering/working in prevention services). Cues to action (including life events such as friend's recent HIV diagnosis) and past service use emerged as the most consistent predictors of intentions and actual service use. Perceived susceptibility, positive expectations, and condomless anal intercourse predicted some categories of service use indirectly through intentions. Contrary to predictions, perceived barriers and personal discomfort predicted intentions but were not predictors of service use. Intentions generally predicted behavior, with the exception of structured service use. This study addressed methodological limitations of prior research and utilized data from a longitudinal sample of MSM to discover predictors of access to HIV prevention services. Understanding who accesses HIV services and why will allow for directed strategies to improve dissemination and utilization. [ABSTRACT FROM AUTHOR]

The clergy occupation is unique in its combination of role strains and higher calling, putting clergy mental health at risk. We surveyed all United Methodist clergy in North Carolina, and 95 % ( n = 1,726) responded, with 38% responding via phone interview. We compared clergy phone interview depression rates, assessed using the Patient Health Questionnaire (PHQ-9), to those of in-person interviews in a representative United States sample that also used the PHQ-9. The clergy depression prevalence was 8.7 %, significantly higher than the 5.5 % rate of the national sample. We used logistic regression to explain depression, and also anxiety, assessed using the Hospital Anxiety and Depression Scale. As hypothesized by effort-reward imbalance theory, several extrinsic demands (job stress, life unpredictability) and intrinsic demands (guilt about not doing enough work, doubting one’s call to ministry) significantly predicted depression and anxiety, as did rewards such as ministry satisfaction and lack of financial stress. The high rate of clergy depression signals the need for preventive policies and programs for clergy. The extrinsic and intrinsic demands and rewards suggest specific actions to improve clergy mental health. [ABSTRACT FROM AUTHOR]