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Service Delivery Innovation Profile

Church-Based Program Encourages African-American Congregants to Increase Consumption of Fruits and Vegetables


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Snapshot

Summary

Body and Soul is a church-based program that encourages African-American congregants to improve their health by eating a diet rich in fruits and vegetables. The program was constructed from two previous research-based programs, taking successful elements from both and adapting them for use by volunteers and lay staff in "real-world" conditions. Program participants have reported significantly greater fruit and vegetable intake as compared with a control group of nonparticipants, with a corresponding decline in fat intake. Program participants also reported significantly greater levels of social support and increased motivation to eat fruits and vegetables as compared with nonparticipants.

Evidence Rating (What is this?)

Strong: The evidence consists of data from a cluster randomized control test of 854 individuals from 15 churches, 8 of which implemented the program and 7 of which did not.
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Developing Organizations

American Cancer Society; Emory University, Department of Behavioral Science and Health Education; National Cancer Institute; University of Michigan, School of Public Health; University of North Carolina at Chapel Hill, Department of Nutrition
end doBody and Soul was first implemented as a demonstration project in 2002. In 2004, efforts began to spread the program throughout the nation.begin pp

Patient Population

Race and Ethnicity > Black or african american; Vulnerable Populations > Racial minoritiesend pp

Problem Addressed

African Americans suffer from a higher incidence of many chronic diseases, including many types of cancer, high blood pressure, diabetes, heart disease, and stroke. Although eating a healthy diet rich in fruits and vegetables can help lower the risk of getting these diseases, African Americans consume fewer fruits and vegetables than do members of other major racial and ethnic groups.1
  • African Americans disproportionately at risk: In 2004, African-American adults were 1.8 times more likely than non-Hispanic Whites to be diagnosed with, and 2.2 times more likely to die from, diabetes. They were also 1.5 times more likely than non-Hispanic Whites to have high blood pressure. In 2004, African-American men were 30 percent more likely to die from heart disease and 1.4 times more likely to be diagnosed with lung or prostate cancer than were non-Hispanic White men. African-American women were 1.7 times more likely to have been diagnosed with, and 2.2 times more likely to die from, stomach cancer than were non-Hispanic White women.2
  • Low intake of fruits and vegetables: Eating a diet rich in fruits and vegetables can reduce the risk of stroke, cardiovascular disease, and diabetes, and can help promote the maintenance of a healthy weight. In addition, consuming at least five daily servings of fruits and vegetables can lower the risk of several cancers, including cancers of the lung, mouth, esophagus, stomach, and colon.3 However, data from the 2005 Behavioral Risk Factor Surveillance System indicate that only 35.1 percent of African Americans surveyed consumed two or more servings of fruit daily, compared with 37.2 percent for Hispanics. Of African Americans surveyed, 23.7 percent consumed two or more servings of vegetables per day, in comparison with 28.6 percent for non-Hispanic Whites.1

What They Did

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Description of the Innovative Activity

Body and Soul is a church-based program that encourages African-American congregants to improve their health by eating a diet rich in fruits and vegetables. Participating churches recruit volunteers from within the congregation to administer and coordinate the program, eliminating the need for paid staff and empowering church members to take charge of their own health. Key components of the program include the following:
  • Pastors as participants and role models: Pastors commit to serving as active participants and role models, increasing their own fruit and vegetable intake and being vocal in their encouragement of congregants who do the same. Pastors are encouraged to use church services, bulletins, and newsletters to deliver inspirational messages about the link between good health, nutrition, and spirituality.
  • Church-wide nutrition activities: Churches implementing the program offer a variety of activities and events, including the following:
    • Kick-off event: Designed to set the tone for the entire program, the kickoff event introduces the congregation to Body and Soul, provides background information on healthy eating and nutrition, and encourages church members to participate. During this kickoff event, attendees typically taste a variety of fruits and vegetables and receive a calendar of upcoming program events. Attendees are also encouraged to sign a pledge affirming their commitment to participation in the program.
    • Ongoing church-based activities: Church members are continuously exposed to fruits, vegetables, and healthy eating habits through church-sponsored recreational and educational activities. Examples of these activities include health fairs, healthy picnics, prayer breakfasts featuring healthy food choices, cooking demonstrations, fruit and vegetable taste tests, tours of the produce department at a local grocery store, and workshops on topics such as healthy eating, weight control, gardening, and food budgeting.
  • Healthy church policies: Churches implementing the program promote and institute church policy changes that create an environment conducive to healthy eating. Such changes include replacing sugary sweets with fruits and vegetables at church functions, stocking church vending machines with healthier food options, starting a garden committee to support a church garden, and providing bags of fresh produce to sick and shut-in church members.
  • Volunteer church coordinator and planning team: Each participating church identifies one volunteer liaison to serve as the church coordinator for the program, as well as a planning team of five to ten people, depending on church size. Usually, these appointments are made by the pastor or health ministry.
    • Church coordinator: The church coordinator manages the program and oversees the planning team. He or she serves as a liaison between Body and Soul and the church, providing the planning team with program information, monitoring the team’s progress, and providing feedback to clergy.
    • Planning team: The planning team is responsible for coordinating and promoting the program and for tracking its success. Team members hold regular meetings, plan and oversee implementation of all activities, ensure that tracking and feedback forms are completed, and participate in celebrating the program’s successes.
  • Volunteer peer counselors: A volunteer peer counseling coordinator recruits several church members to serve as volunteer peer counselors. Although not required, Body and Soul recommends that individuals chosen for this role have a college degree and/or a background in a "helping profession." The peer counseling system is based on principles of motivational interviewing, a client-centered approach that employs techniques of reflective listening and autonomy support to change health-related behaviors.4 Church members sign up to speak with a peer counselor, either in person or on the phone. Counselors listen, provide nonjudgmental support, and work with church members to develop an action plan for eating more fruits and vegetables.
  • Education and training materials: Body and Soul provides all participating churches with a free training DVD for peer counselors that contains a variety of skill-building and role-playing exercises, along with printable materials to help prepare peer counselors for their new role. In addition, the program offers participating churches a peer counseling coordinator's guide, a peer counselor's handbook, and a program implementation guide, all of which can be downloaded free of charge from the program's Web site. A healthy cookbook and a variety of colorful posters celebrating fruits and vegetables are also available without charge from the Web site.

Context of the Innovation

Body and Soul was constructed from two independently developed church-based programs: Black Churches United for Better Health, a 4-year project funded by NCI and conducted by the University of North Carolina within 50 African-American churches; and Eat for Life, a collaborative NCI-funded effort between Emory University and African-American churches in Atlanta. Both programs focused on increasing fruit and vegetable intake among congregants of African-American churches, and both were found to be effective in separate, randomized control trials.4 In 2001, the two research groups responsible for these programs teamed with the national office of the American Cancer Society (ACS) and NCI to create an aggregate intervention that combined elements of both programs; this effort was designed in part to address ACS' interest in sponsoring a cancer control program for an underserved population. Although Black Churches United for Better Health and Eat for Life made use of professionals and paid staff, this hybrid program, known as Body and Soul, was designed to use volunteer church members who received modest levels of training and support and worked under real-world conditions. The program was launched as a demonstration project in 2002, under the primary direction of ACS. In 2003, NCI took over the program, and began disseminating it nationally in 2004 as part of its Office of Communications and Education. In January 2010, NCI ended funding for dissemination efforts.

Did It Work?

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Results

A cluster, randomized control test of 854 participants from 15 churches (8 that implemented the program and 7 that did not) found that program participants reported significantly greater fruit and vegetable intake as compared with control group participants, with a corresponding decline in fat intake. Program participants also reported significantly greater levels of social support and increased motivation to eat fruits and vegetables as compared with control group participants.4
  • Greater consumption of fruits and vegetables: Self-report questionnaires administered at baseline and 6 months after program implementation found that participants in Body and Soul reported significantly greater intake of fruits and vegetables than did control group participants, eating an average of 0.7 to 1.4 more servings per day.
  • Less fat intake: The National Cancer Institute (NCI) Fat Screener tool was used to assess fat intake; analysis showed that the percentage of total calories that came from fat was significantly lower among program participants than among members of the control group.
  • Increased motivation and social support: Participants reported significantly greater levels of social support and intrinsic and extrinsic motivation to eat fruits and vegetables than did members of the control group.

Evidence Rating (What is this?)

Strong: The evidence consists of data from a cluster randomized control test of 854 individuals from 15 churches, 8 of which implemented the program and 7 of which did not.

How They Did It

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Planning and Development Process

Key steps in the planning and development process include the following:
  • Choosing program components: Project developers selected key components from Black Churches United for Better Health and Eat for Life to be incorporated in Body and Soul. Developers chose aspects of the programs that had been tested and found to contribute significantly to positive results, as well as components that were deemed to have the potential to be widely disseminated and implemented.
  • Obtaining funding for demonstration project: Program developers solicited and received major funding from NCI and ACS for the program. (See the Funding Sources section below for more details.)
  • Conducting small-scale pilot test and focus group: ACS recruited participants from four to five churches to take part in a small-scale pilot test of the program. Participating churches implemented various aspects of the program and provided feedback on what elements were most useful to them. ACS then held a focus group with congregants who participated to discuss their impressions of the program; feedback served to inform the implementation of a larger demonstration project.
  • Recruiting churches for the larger demonstration project: Program developers recruited churches for a larger demonstration project through local ACS offices in California, the Southeast (Georgia, North Carolina, South Carolina), and the mid-Atlantic (Delaware, Virginia). A total of 15 churches agreed to participate.
  • Training program volunteers: For the larger demonstration project, volunteer church coordinators received 1 to 2 hours of formal training in program implementation from ACS staff. Peer counselors attended weekend-long training sessions conducted by experienced Emory University staff. Since the program's nationwide dissemination began, the training process has become somewhat less standardized. Volunteers from participating churches may or may not receive formal outside training, depending on location. All churches, regardless of location, are encouraged to train their peer counselors using Body and Soul’s free peer counselor training DVD. As noted, peer counseling coordinators can also download a free guide that offers guidance in using the DVD to train volunteer counselors.
  • Refining program for national launch: In 2003, NCI took over dissemination of the program as a part of their Five a Day for Better Health initiative, using a broad-based media approach, including Web-based materials and advertising/publicity in major magazines, to promote the program to the African-American community. When the program shifted to NCI's Office of Communications and Education in 2004, it was determined that not all churches were implementing the program as recommended. As a result, NCI is currently testing a dissemination strategy that aims to promote greater continuity and fidelity to program elements among churches that implement Body and Soul. (See the Additional Considerations and Lessons section for more information on this dissemination strategy.)

Resources Used and Skills Needed

  • Staffing: Staffing levels for the program have varied throughout the stages of its dissemination, first as a demonstration project and later during its expansion across the nation. During the demonstration project, two full-time national ACS staff members worked on Body and Soul as part of their ACS job responsibilities, with additional regional staff assisting with training and support. During the national dissemination, two full-time NCI staff members work on Body and Soul, along with an additional part-time contractor and a full-time intern. Additionally, NCI's Cancer Information Service Partnership Program staff of approximately 80 provide training and technical assistance to organizations disseminating the program. The Cancer Information Service program is regionalized and covers the entire United States, Puerto Rico, the U.S. Virgin Islands, and the Pacific Island Jurisdictions.
  • Costs: During the research phase of the Body and Soul demonstration project, one major program cost consisted of incentives for churches to have participants fill out pre- and postprogram interviews and questionnaires. Churches participating in the demonstration project received $5 for each completed baseline participant interview (up to $100 per church), and an additional $5 for each completed posttest questionnaire. Churches received an additional $500 if they obtained posttest questionnaires from at least 90 percent of their baseline participants. Costs for churches currently implementing Body and Soul as disseminated by NCI are much more variable. Body and Soul was developed to leverage health promotion resources that already exist to address risk behaviors among African Americans; as such, churches and community based organizations are not expected to develop new resources to support the program. Since the implementation of Body and Soul varies based on the size of participating churches and the nature and level of activities planned, costs can be hard to quantify. Most churches are able to use existing budgets for food and printing to cover the costs of purchasing fruits and vegetables and creating promotional materials, and/or partner with local businesses to subsidize these expenses.
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Funding Sources

American Cancer Society; Centers for Disease Control and Prevention; National Cancer Institute
ACS funded (both through direct expenditure and in-kind contributions) the costs associated with developing and implementing the demonstration project, including designing, modifying and reproducing intervention materials, recruiting churches, and covering the costs of the coordinator and training sessions. NCI provided funds to evaluate program processes and outcomes. NCI also provided contract support through the Cancer Information Service Partnership Program to disseminate the program. The Centers for Disease Control and Prevention (CDC) provided additional funding for research on the program's dissemination.end fs

Tools and Other Resources

NCI's Fat Screener Tool is available at http://www.riskfactor.cancer.gov/diet/screeners/fat/.

Adoption Considerations

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Getting Started with This Innovation

  • Involve churches in planning stages: Seek input from African-American churches when designing core components of the program. Community participation and engagement will give the program an implicit seal of approval.
  • Mobilize churches to get involved: Rather than informing churches and their congregants that they need the intervention, build intrinsic motivation to participate by introducing them to the program's mission and exploring how that mission might help them meet internal goals.
  • Seek partnerships: Collaborating with local and national partners who share a commitment to the issues being addressed can help to generate innovative ideas and secure financial support.

Sustaining This Innovation

  • Monitor program outcomes: Conducting a program evaluation, even at a basic level, helps to identify and document program successes and to stimulate continuous improvement.
  • Let the program evolve over time: Keep the program fresh and relevant by adding new content over time.
  • Aim for consistency in dissemination: Help participating churches implement the program with fidelity to its core elements. (See Additional Considerations and Lessons for more details on a program designed to achieve this goal.)

Additional Considerations

  • From 2006 to 2007, NCI tested a dissemination strategy aimed at increasing the fidelity to program elements among churches implementing Body and Soul. As part of this work, NCI formed new partnerships—and enhanced existing ones—with a number of national institutions and networks, including ACS, CDC, the U.S. Department of Agriculture, several 1890 land grant institutions, faith-based organizations/initiatives, and interfaith alliances. NCI trained representatives from each of these partnering institutions to serve as dissemination agents who support participating churches in implementing the program. In addition, NCI utilized 15 regional offices of its Cancer Information Service Partnership Program to train more than 70 staff from across the country to also serve as dissemination agents. NCI provided these agents with intensive training in implementing Body and Soul, including support tools to use when working with churches. In addition, NCI developed a password-protected Web site, where agents can download training and evaluation instruments, share and receive information about churches currently implementing the program, and utilize an "Ask-the-Expert" feature to receive answers to questions regarding dissemination of best practices. NCI ended data collection on the study of this dissemination strategy in late 2007, with data still being evaluated. In January 2010, NCI ended funding for program dissemination.

More Information

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Contact the Innovator

Ken Resnicow, PhD
Professor
University of Michigan
School of Public Health
Department of Health Behavior and Health Education
109 Observatory Street
Room 3867 SPH I
Ann Arbor, MI 48109-2029
Office Phone: (734) 647-0212
Cell Phone: (734) 904-3888
Office Fax: (734) 763-7379
E-mail: kresnic@umich.edu

Innovator Disclosures

Dr. Resnicow has not indicated whether he has financial interests or business/professional affiliations relevant to the work described in this profile; however, information on funders is available in the Funding Sources section.

References/Related Articles

See the related Healthcare 411 podcast Church-Based Program Helps African Americans Eat Healthier conducted on February 27, 2013 with Bishop P.A. Brooks.

Footnotes

1 Centers for Disease Control and Prevention. Fruit and vegetable consumption among adults—United States 2005. MMRW Morb Mortal Wkly Rep. 2007 Mar 16;56(10):213-7. [PubMed] Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5610a2.htm?s_cid=mm5610a2_e
2 Department of Health and Human Services Office of Minority Health. African-American Profile [Web site]. 2011. Available at: http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=51
3 American Cancer Society. Diet and Physical Activity: What's the Cancer Connection? [Web site]. 2006. Available at: http://www.cancer.org/Cancer/CancerCauses/DietandPhysicalActivity/diet-and-physical-activity
4 Resnicow K, Campbell MK, Carr C, et al. Body and soul. A dietary intervention conducted through African-American churches. Am J Prev Med. 2004;27(2):97-105. [PubMed]
Comment on this Innovation

Disclaimer: The inclusion of an innovation in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, or Westat of the innovation or of the submitter or developer of the innovation. Read more.

Original publication: February 02, 2009.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: May 29, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: February 22, 2011.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.