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Objective: Churches are frequently used to reach Black adults to effect weight loss. However, there has been no recent review, to our knowledge, inclusive of solely Black adults in church settings. We sought to comprehensively examine the methodological approaches and weight-loss outcomes of church-based weight-loss lifestyle interventions conducted among Black adults to provide insights on literature gaps and offer suggestions for future research., Methods: Google Scholar, PubMed, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) were searched for trials conducted in churches that reported weight outcomes at any time point. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guided manuscript development., Results: A total of 15 studies (N = 2285) from 2007 to 2023 met inclusion criteria, and 33% were high-quality randomized trials. The majority were pilot studies (60%) conducted in the Southern United States. Most reported significant postintervention weight loss. The follow-up time points varied from 2 to 12 months. Methodological approaches included the following: cultural adaptations (93%); theory-guided (93%); delivered by community health workers (80%); and delivered in person in a group format (100%). Only one study offered individual-level attention beyond texts/emails. Most participants were well-educated female individuals., Conclusions: Weight-loss interventions among Black church settings effect statistically significant weight loss, albeit in a small way. Limitations include pilot studies and small samples. More rigorously designed studies are warranted., (© 2024 The Author(s). Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society.)

Background: Pacific Islanders in the United States have lower initiation rates and shorter duration of exclusive breastfeeding compared to other racial/ethnic groups., Research Aim: To describe infant feeding beliefs and experiences of Marshallese living in the United States., Methods: We used a prospective and cross-sectional exploratory, descriptive qualitative design with Marshallese participants ( N = 36) residing in the United States between July 2019 and July 2020. Data were collected at 6-8 weeks postpartum. Our qualitative analytic approach integrated inductive and deductive techniques., Results: Participants' mean age was 27.1 years ( SD = 6.1), and 88.9% ( n = 32) were born in the Marshall Islands. A majority of participants were single, widowed, or in an unmarried partnership ( n = 28, 77.8%). Most participants had a high school education or lower ( n = 30, 83.3%). Mean household size was 7.2 ( SD = 2.8). Fewer than half of participants had no health insurance ( n = 14, 38.9%), and almost all participants (91.7%) did not work at the time of data collection. Two themes emerged: 1) infant feeding initiation and practices; and 2) concerns over breastfeeding in public. The majority of participants' infants received both human milk and formula. Participants described beliefs that breastfeeding in public was against American customs, which influenced their decision about breastfeeding in public., Conclusions: Our study was the first to document infant feeding beliefs and experiences of Marshallese living in the United States at 6-8 weeks postpartum. Findings will inform future health education programs.

Objective: Examine cross-sectional associations between body mass index (BMI) and related health behaviors, barriers and facilitators to health care, and perceived health status among a sample of U.S. Marshallese adults with Type 2 diabetes and evaluate associations of interest between participants and their family members. Design: Cross-sectional baseline data were analyzed from participants in a diabetes self-management education intervention trial. Setting: Data collection took place in home or community settings through a community-academic partnership in Arkansas. Participants: Study participants consisted of U.S. Marshallese adults with Type 2 diabetes ( N  = 221) and their family members ( N  = 211) recruited through community settings. Intervention(s): N/A. Main Outcome Measure(s): Participants' height and weight were measured using standard protocols to calculate BMI (kg/m 2 ). Diet, physical activity, health care access, financial strain related to health care, perceived health status, and health care satisfaction were measured using self-report surveys. Results: Participants' mean BMI was 31.0 (95% CI: 30.2-31.7), with over half of study participants and their family members' BMI falling in the obese category. Participants' BMI was positively associated with spreading health care bill payments over time ( β  = 1.75 (SE = 0.87); p  = 0.045). Positive associations between participants and their family members were observed for self-reported health status conditions, health care coverage, health care utilization, and health care satisfaction. Conclusion: Study findings highlight the high prevalence of obesity and related risk factors among U.S. Marshallese adults with Type 2 diabetes and emphasize the need for intervention strategies that build upon cultural strengths and target community, policy, systems, and environmental changes to address obesity and chronic disease in this marginalized community.

Background: Community subcontracts are an essential component of community-engaged research, particularly community-based participatory research (CBPR). However, several barriers have limited community-based organizations' (CBOs) ability to serve as subcontractors on research grants. This article describes the barriers and strategies to implementing community subcontracts through a case study of the implementation of one federal grant., Lessons Learned: Specific lessons learned at the CBO level, budget-creation level, and university-level are described to overcome barriers in executing community subcontracts in community-engaged research., Conclusions: We call for institutional changes to facilitate equitable resource sharing in community-engaged research.

The Problem: Dissemination is a key component of translational research. However, research participants rarely receive findings from the studies in which they have participated. Funding agencies have a significant amount of influence to promote research dissemination through requirements, recommendations, and tools. However, it is not clear to what extent current funding agencies promote dissemination to study participants.Purpose of Article: A review of major health research funders was conducted to ascertain the current policies, recommendations, and tools related to 1) academic dissemination, 2) lay community dissemination, and 3) returning results to research participants., Key Points: Several agencies have policies, recommendations, and tools for academic dissemination; however, few have the same policies, recommendations, and tools for dissemination to research participants and the lay communities they are recruited from., Conclusions: Funding agencies have a unique opportunity to encourage the dissemination of research results to research participants and lay community audiences by developing policies to increase dissemination of grantees' research findings.

This article illustrates how a collaborative research process can successfully engage an underserved minority community to address health disparities. Pacific Islanders, including the Marshallese, are one of the fastest growing US populations. They face significant health disparities, including extremely high rates of type 2 diabetes. This article describes the engagement process of designing patient-centered outcomes research with Marshallese stakeholders, highlighting the specific influences of their input on a randomized control trial to address diabetes. Over 18 months, an interdisciplinary research team used community-based participatory principles to conduct patient-engaged outcomes research that involved 31 stakeholders in all aspects of research design, from defining the research question to making decisions about budgets and staffing. This required academic researcher flexibility, but yielded a design linking scientific methodology with community wisdom., (© 2016 John Wiley & Sons Ltd.)

Background: Type 2 diabetes (T2D) is a significant public health problem, with U.S. Pacific Islander communities-such as the Marshallese-bearing a disproportionate burden. Using a community-based participatory approach (CBPR) that engages the strong family-based social infrastructure characteristic of Marshallese communities is a promising way to manage T2D., Objectives: Led by a collaborative community-academic partnership, the Family Model of Diabetes Self-Management Education (DSME) aimed to change diabetes management behaviors to improve glycemic control in Marshallese adults with T2D by engaging the entire family., Design: To test the Family Model of DSME, a randomized, controlled, comparative effectiveness trial with 240 primary participants was implemented. Half of the primary participants were randomly assigned to the Standard DSME and half were randomly assigned to the Family Model DSME. Both arms received ten hours of content comprised of 6-8 sessions delivered over a 6-8 week period., Methods: The Family Model DSME was a cultural adaptation of DSME, whereby the intervention focused on engaging family support for the primary participant with T2D. The Standard DSME was delivered to the primary participant in a community-based group format. Primary participants and participating family members were assessed at baseline and immediate post-intervention, and will also be assessed at 6 and 12 months., Summary: The Family Model of DSME aimed to improve glycemic control in Marshallese with T2D. The utilization of a CBPR approach that involves the local stakeholders and the engagement of the family-based social infrastructure of Marshallese communities increase potential for the intervention's success and sustainability.

Background: Academic partners typically build community capacity for research, but few examples exist whereby community partners build community research capacity. This paper describes the benefits of communities sharing their "best practices" with each other for the purpose of building health research capacity., Methods: In the context of a grant designed to engage African American communities to address health disparities (Faith Academic Initiatives Transforming Health [FAITH] in the Delta), leaders of two counties exchanged their "best practices" of creating faith-based networks and community health assessment tools to conduct a collective health assessment., Lessons Learned: There were numerous strengths in engaging communities to build each other's capacity to conduct research. Communities identified with each other, perceived genuineness, conveyed legitimacy, and provided insider knowledge., Conclusions: Engaging communities to build each other's research capacity is a potentially valuable strategy.

Background: Type 2 diabetes is a significant public health problem, with U.S. Pacific Islander communities bearing a disproportionate burden. The Marshallese are a Pacific Islander community that has significant inequities in diabetes, yet few evidence-based diabetes interventions have been developed to address this inequity., Objectives: We used a community-based participatory research (CBPR) approach to adapt an evidence-based diabetes self-management education (DSME) intervention for the Marshallese., Methods: Our team used the Cultural Adaptation Process Model, in addition to an iterative process consisting of formative data and previous literature review, and engagement with community and academic experts., Lessons Learned: Specific cultural considerations were identified in adapting DSME components, including the dichotomous versus gradient conceptualization of ideas, the importance of engaging the entire family, the use of nature analogies, and the role of spirituality., Conclusions: We identified key cultural considerations to incorporate into a diabetes self-management program for the Marshallese. The insights gained can inform others' work with Pacific Islanders.

Background: Health assessments are used to prioritize community-level health concerns, but the role of individuals' health concerns and experiences is unknown. We sought to understand to what extent community health assessments reflect health concerns of the community-at-large versus a representation of the participants sampled., Methods: We conducted a health assessment survey in 30 rural African American churches (n = 412). Multivariable logistic regression produced odds ratios examining associations between personal health concern (this health concern is important to me), personal health experience (I have been diagnosed with this health issue) and community health priorities (this health concern is important to the community) for 20 health issues., Results: Respondents reported significant associations for 19/20 health conditions between personal health concern and the ranking of that concern as a community priority (all P < 0.05). Inconsistent associations were seen between personal health experience of a specific health condition and the ranking of that condition as a community priority., Conclusions: Personal health concerns reported by individuals in a study sample may impact prioritization of community health initiatives. Further research should examine how personal health concerns are formed., (© The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The positive effects of weight loss on obesity-related risk factors diminish unless weight loss is maintained. Yet little work has focused on the translation of evidence-based weight loss interventions with the aim of sustaining weight loss in underserved populations. Using a community-based participatory approach (CBPR) that engages the strong faith-based social infrastructure characteristic of rural African American communities is a promising way to sustain weight loss in African Americans, who bear a disproportionate burden of the obesity epidemic., Objectives: Led by a collaborative community-academic partnership, The WORD aims to change dietary and physical activity behaviors to produce and maintain weight loss in rural, African American adults of faith., Design: The WORD is a randomized controlled trial with 450 participants nested within 30 churches. All churches will receive a 16-session core weight loss intervention. Half of the churches will be randomized to receive an additional 12-session maintenance component., Methods: The WORD is a cultural adaptation of the Diabetes Prevention Program, whereby small groups will be led by trained church members. Participants will be assessed at baseline, 6, 12, and 18 months. A detailed cost-effectiveness and process evaluation will be included., Summary: The WORD aims to sustain weight loss in rural African Americans. The utilization of a CBPR approach and the engagement of the faith-based social infrastructure of African American communities will maximize the intervention's sustainability. Unique aspects of this trial include the focus on weight loss maintenance and the use of a faith-based CBPR approach in translating evidence-based obesity interventions., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Purpose: Racial and geographic disparities in human immunodeficency virus (HIV) are dramatic and drug use is a significant contributor to HIV risk. Within the rural South, African Americans who use drugs are at extremely high risk. Due to the importance of religion within African American and rural Southern communities, it can be a key element of culturally-targeted health promotion with these populations. Studies have examined religion's relationship with sexual risk in adolescent populations, but few have examined specific religious behaviors and sexual risk behaviors among drug-using African American adults. This study examined the relationship between well-defined dimensions of religion and specific sexual behaviors among African Americans who use cocaine living in the rural southern United States., Methods: Baseline data from a sexual risk reduction intervention for African Americans who use cocaine living in rural Arkansas (N = 205) were used to conduct bivariate and multivariate analyses examining the association between multiple sexual risk behaviors and key dimensions of religion including religious preference, private and public religious participation, religious coping, and God-based, congregation-based, and church leader-based religious support., Findings: After adjusting individualized network estimator weights based on the recruitment strategy, different dimensions of religion had inverse relationships with sexual risk behavior, including church leadership support with number of unprotected vaginal/anal sexual encounter and positive religious coping with number of sexual partners and with total number of vaginal/anal sexual encounters., Conclusion: Results suggest that specific dimensions of religion may have protective effects on certain types of sexual behavior, which may have important research implications., (© 2014 National Rural Health Association.)

Objective: The aim of this study was to explore how a rural African American faith community would address depression within their congregations and the community as a whole., Design and Sample: A qualitative, interpretive descriptive methodology was used. The sample included 24 participants representing pastors, parishioners interested in health, and African American men who had experienced symptoms of depression in a community in the Arkansas Delta., Measures: The primary data sources for this qualitative research study were focus groups., Results: Participants identified three key players in the rural African American faith community who can combat depression: the Church, the Pastor/Clergy, and the Layperson. The roles of each were identified and recommendations for each to address depression disparities in rural African Americans., Conclusions: The recommendations can be used to develop faith-based interventions for depression targeting the African American faith community., (© 2013 Wiley Periodicals, Inc.)

We examined the factors associated with screening mammography adherence behaviors and influencing factors on women's attitudes toward mammography in non-adherent women. Design-based logistic regression models were developed to characterize the influencing factors, including socio-demographic, health related, behavioral characteristics, and knowledge of breast cancer/mammography, on women's compliance with and attitudes toward mammography using the 2003 Health Information National Trends Survey data. Findings indicate significant associations among adherence to mammography and marital status, income, health coverage, being advised by a doctor to have a mammogram, having had Pap smear before, perception of chance of getting breast cancer, and knowledge of mammography (frequency of doing mammogram) in both women younger than 65 and women aged 65 and older. However, number of visits to a healthcare provider per year and lifetime number of smoked cigarettes are only significant for women younger than 65. Factors significantly associated with attitudes toward mammography in non-adherent women are age, being advised by a doctor to have a mammogram, and seeking cancer information. To enhance adherence to mammography programs, physicians need to continue to advise their patients to obtain mammograms. In addition, increasing women's knowledge about the frequency and starting age for screening mammography may improve women's adherence. Financially related factors such as income and insurance are also shown to be significant factors. Hence, healthcare policies aimed at providing breast cancer screening services to underserved women will likely enhance mammography participation.

Churches have been a popular site for the implementation of health promotion interventions. Although the efficacy of church-based health programs have been established, it is unknown which aspects of church-based health promotion drive health behavior change. Process evaluation is a way to increase our understanding of key components of church-based health promotion and to move the field forward. Thus, a systematic review of the utilization of process evaluation in church-based health programs was conducted. Articles from 1990 to 2008 were screened for eligibility, resulting in the analysis of 67 articles. The majority of church-based health programs assessed recruitment (88.1%) and reach (80.6%). About 28.4% assessed dose delivered, and 27.3% measured dose received. Context and fidelity was assessed by 34.3% and 20.9%, respectively, of church-based interventions. Approximately 9% of church-based programs measured fidelity. On average, only three of seven possible components of process evaluation were measured among the studies reviewed. The number of process evaluation components assessed did not differ by program feature (e.g., target population, target health condition, program objective, etc.). Consistency in the conceptualization and measurement of process evaluation may facilitate the implementation of a comprehensive process evaluation effort in church-based and other health promotion interventions.

Introduction: Colorectal cancer is a common disease, and incidence and death rates are higher in medically underserved populations. The colorectal cancer death rate in Arkansas exceeds the national rate. The objective of this study was to examine population characteristics relevant to the design and implementation of a state-sponsored colorectal cancer screening program that is responsive to medically underserved populations., Methods: Trained interviewers in 2006 conducted a random-digit-dialed telephone survey comprising items selected from the Health Information National Trends Survey to characterize demographic factors, health care variables, and colorectal screening history in a sample (n = 2,021) representative of the Arkansas population. Univariate and multivariate analyses identified associations among population characteristics and screening status., Results: Participants who were aged 50 to 64, who did not have health insurance, or who had an annual household income of $15,000 or less were significantly less likely than their counterparts to be in compliance with screening guidelines. Those who reported having a health care provider, having 5 or more health care visits during the past year, and receiving physician advice for colorectal screening were more likely to be in compliance with screening guidelines. Although a larger percentage of white participants were in compliance with screening guidelines, blacks had higher screening rates than whites when we controlled for screening advice., Conclusion: Survey results informed efforts to decrease disparities in colorectal cancer screening in Arkansas. Efforts should focus on reimbursing providers and patients for screening costs, encouraging the use of physicians as a point of entry to screening programs, and promoting a balanced approach (ie, multiple options) to screening recommendations. Our methods established a model for developing screening programs for medically underserved populations.

The Arkansas Cancer Connection Program is a community-academic partnership between the University of Arkansas for Medical Sciences and nine community-based coalitions designed to address cancer health disparities through community-based participatory research. In 2005, a survey measuring coalition capacity was administered to 51 Cancer Council members to assess training needs and increase coalition capacity. The highest scoring components were leadership and member engagement while the lowest were development and capacity effectiveness. Effectiveness correlated with aspects of coalition capacity. The evaluation identified training needs, which were met by projects leveraging the coalition's strengths to advance community-based participatory research addressing cancer disparities.

Disparities in breast cancer survival rates suggest that biological processes contribute. Translational research addressing health disparities would benefit from using a community-based participatory approach (CBPR) to examine biological processes commonly seen as the proximal causes of illness as well as behavioral and social-ecological "causes of the causes" within an integrated conceptual framework. This paper describes a CBPR study that explored perceptions regarding breast cancer relevant behaviors, and the application of the study's results to develop translational research. Data from eight focus groups of African American (n = 29) and Caucasian women (n = 27) were analyzed, using the framework of the social-ecological model. Nutrition and physical activity were valued over screening and research participation. Treatment of illness was emphasized over prevention. Women's perspectives are presented within a framework that facilitated the collaborative development of translational research to examine associations among biological, behavioral, and societal processes contributing to disparities.