African-American Churches are Key Partners in Addressing Health Challenges
The COVID-19 pandemic disproportionately affected communities of color, particularly African-Americans (AAs), exacerbating health disparities. Reference Cyrus, Clarke and Hadley1 Since 78% of AAs report belonging to religious organizations, the Fostering African-American Improvement in Total Health! (FAITH!) Program leveraged a successful, longstanding community-academic partnership in April 2020, Reference Brewer and Williams2–Reference Brewer, Balls-Berry, Dean, Lackore, Jenkins and Hayes6 by providing emergency preparedness (EP) plans and COVID-19 information to AA churches in Rochester and Minneapolis-St. Paul (MSP), MN. Reference Brewer, Asiedu and Jones7 This mixed-methods study evaluated the initiative’s impact on EP promotion within AA communities during the pandemic; assessing church readiness for future public health emergencies, intervention engagement, dissemination, and satisfaction.
Methods
Intervention/Context
From April to May 2020, an 8-week EP risk communication intervention was co-developed with AA churches in Rochester and MSP (AAs 9.1% and 18.4% of population, respectively). In the intervention areas, an estimated 60% of AAs attend Christian congregations. Employing a community-based participatory research approach and a framework adapted from the Centers for Disease Control and Prevention (CDC) Crisis and Emergency Risk Communication framework, a needs assessment was conducted to understand pandemic-related challenges faced by the AA community. Intervention details have been previously published. Reference Brewer, Asiedu and Jones7 Based on the needs assessment, a faith-based, COVID-19 EP manual was electronically communicated. Reference Brewer, Asiedu and Jones7 The manual offered step-by-step guidance for structuring church EP initiatives and establishing EP teams (EPTs). Additionally, a culturally tailored social marketing campaign was launched to communicate inspirational, health, and financial, as well as social support messages. The “FAITH! & COVID-19 Spread the Word!” newsletter, co-developed with community leaders, was sent weekly to congregations via email containing scripture-based information to reinforce messages.
Data Collection
The Mayo Clinic Institutional Review Board approved this study. Following informed consent, AA church leaders participated in individual, 1-hour, semi-structured interviews (June–July 2020) via videoconferencing and telephone using a standardized moderator guide. All interviews were recorded and transcribed. Participants received US $50 cash card for interview completion. Churches also received US $500 monetary incentives to enhance EPTs.
Outcomes
We assessed whether churches had an established EPT and the perceived level of church EP at pre- and post-intervention. Furthermore, the intervention was evaluated on engagement, dissemination, satisfaction, and recommendations/suggestions for sustainability.
Analyses
Participant characteristics were summarized using mean, median, and proportions. Initial themes and categories were compiled using an integrated approach of inductive codes emerging from the data and a priori codes derived from interview questions. Multiple readings were conducted to identify preliminary themes. Quantitative analysis utilized SPSS Statistics Version 25 (IBM Corp., Armonk, NY, USA) and qualitative analysis used QSR NVivo software, v10 (Doncaster, Victoria, Australia).
Results
Quantitative Results
Fifteen church leaders were interviewed (response rate: 47% [15 / 32 churches]). Mean age was 60 (SD 9.3) years, with a majority being women (n = 12, 80%). Most were pastors and health coordinators (n = 8, 54%). Representing churches were mainly in MSP (n = 12, 80%); and the median congregation size was 85 members.
Table 1 displays church EP and intervention evaluation. Pre-intervention, 73% (n = 11) of the churches had a health ministry, while only 27% (n = 4) had an established EPT. About 40% (n = 4) of church leaders felt their churches were prepared for a health crisis. Post-intervention, 73% (n = 11) had established an EPT (or equivalent structure), and 3 leaders planned future EPTs. All 15 churches reported increased readiness for the ongoing pandemic and future health crises.
Table 1. Church emergency preparedness and evaluation of the FAITH! emergency preparedness and risk communication initiative
The FAITH! EP intervention (n = 8, 53%) ranked among the top 3 reliable COVID-19 information sources, alongside the governor’s briefings (n = 8, 53%) and the CDC (n = 7, 47%). Of 13 leaders receiving weekly emails, 85% (n = 11) shared information with their congregations. Among 7 churches receiving the EP manual, 57% (n = 4) used it to establish or enhance EPTs. Although 67% (n = 10) knew of the FAITH! Facebook page, only 30% (n = 3) interacted with its content. All leaders who received emails and the EP manual found them helpful for mitigating the pandemic.
Qualitative Results
Thematic analysis of semi-structured interviews yielded 4 themes (Table 2) with no differences by interview mode (videoconferencing vs. telephone).
Table 2. Perceptions of FAITH! emergency preparedness and risk communication initiative
“Perceived Level of Church EP” indicated pre-intervention unpreparedness for health crises like the pandemic. Improved EP post-intervention was attributed to adherence to recommended standards, enhanced knowledge, technology integration, and better communication strategies.
“Intervention Engagement/ Dissemination” underscored the EP manual’s adaptability and its role in launching EPTs. The majority of church leaders valued the weekly emails, finding them highly informative and relevant in addressing pandemic-related needs. Instead of forwarding the emails, leaders often summarized key points for distribution through church communication channels (e.g., email and websites).
“Intervention Satisfaction” revealed that the FAITH! EP intervention significantly impacted EP via the manual. The manual was praised for its accessibility and cultural appropriateness, although some participants cited time constraints and pandemic-related demands as hindrances to fully reviewing and implementing its contents.
The “Intervention Sustainability” theme featured church leaders’ recommendations for long-term impact. They proposed sustaining the intervention by including community health needs (e.g., cancer screening), expanding prevention efforts (e.g., distributing hand sanitizers), incorporating non-COVID-19 healthy lifestyle information, and converting the manual into webinars for increased accessibility.
Discussion
This community-centric intervention improved EP in AA churches by establishing new, and enhancing existing EPTs for health crises, including infectious disease outbreaks. The COVID-19 EP manual aided crisis mitigation efforts led by the EPTs. Participants found the intervention messaging reliable and useful. Similar initiatives addressed vulnerable communities’ needs elsewhere in the US but lacked an EP focus. Reference Joseph, Glover and Olayiwola8,Reference Hall, Winterbauer and Klinger9 This study underscores the need for immediately deployable, sustainable EP tools (e.g., the FAITH! EP intervention) for church leaders to effectively navigate disasters and keep parishioners safe.
The small sample size and localized geographic region limits generalizability of findings beyond these communities. Nevertheless, we achieved interview saturation, underscoring the validity of the findings and offering valuable insights for enhancing EP in under-resourced AA communities. Effective information communication is crucial in the digital transformation era. Participants recommended concise formats, leading to a FAITH! program webinar series covering EP essentials. This highlighted the need for user-friendly digital toolkits in future interventions. Importantly, contextualizing EP strategies is crucial, particularly in socioeconomically disadvantaged communities where unmet or neglected needs are prevalent. Reference Jennings, Arras, Jennings, Arras, Barrett and Ellis10
Conclusion
Equipping churches equitably with EP resources and tailoring resources through EP assessment are pivotal for effective crisis response in AA communities.
Acknowledgments
We extend our gratitude to the FAITH Community Steering Committee members for their valuable input and support. We also thank the partnering church congregations for their dedication to the Mayo Clinic FAITH! program in promoting health and wellness during challenging times. Finally, we acknowledge and appreciate the SNG Corporation for conducting the interviews and compiling initial qualitative themes and categories.
Author contributions
Conception: Asiedu, Brewer, Doubeni, and Erickson, as well as Jones, Richard, Sia, and Weis; White and Wieland also assisted in conceptualizing the work.
Design: Asiedu, Brewer, Doubeni, and Erickson, as well as Jones, Richard, Sia, and Weis; White and Wieland also assisted in the project design stage.
Data analysis: Asiedu, Brewer, Lalika, and Salinas
Data interpretation: Asiedu, Brewer, Jones, Lalika, Salinas
Drafting of the manuscript: Abbenyi, Asiedu, Brewer, Brockman, Doubeni, Erickson, Jones, Lalika, Richard, Salinas, Sia, Weis, White, Wieland
Sources of support
National Center for Advancing Translational Science (NCATS) (CTSA grant no. UL1 TR000135 to the Mayo Clinic);
Mayo Clinic Center for Health Equity and Community Engagement in Research;
Association of Black Cardiologists, Incorporated
NCATS (CTSA grant no. KL2 TR002379);
American Heart Association-Amos Medical Faculty Development Program (grant no. 19AMFDP35040005);
National Institutes of Health (NIH)/National Institute on Minority Health and Health Disparities (grant no. 1 R21 MD013490-01); and
CDC (grant no. CDC-DP18-1817).
Competing interests
All authors declare no competing financial interest.
Abbreviations
AA, African American; CDC,
Centers for Disease Control and Prevention; EP,
Emergency Preparedness; EPT,
Emergency Preparedness Team;
FAITH!, Fostering African-American Improvement in Total Health!;
MSP, Minneapolis-St. Paul.
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