Heaven and Health: How Black,Latino, and Korean Christians View the Relationship Between Faith and Health

Religious congregations have increasingly been viewed as potential access points to health care in underserved communities. Such a perspective stems from a robust literature identifying the unique civic role that churches potentially play in African American and Latino communities. Yet, research on congregational health promotion has often not considered how congregants view the connections between religious faith, physical health, and the church community. In order to further interrogate how congregants view the church’s role in health promotion, we compare views on the relationship between faith and health for two groups that are overrepresented in American Christianity and underrepresented in medical careers (African Americans and Latinos) with a group that is similarly religious but comparatively well-represented in medical professions (Korean Americans). Drawing on data from focus groups with 19 pastors representing 18 different congregations and 28 interviews with church members, we find that churches across all three groups promote initiatives to care for the physical health of their members. Nonetheless, notable differences exist in how each group frames the interface between religious faith and physical health. African Americans and Latinos highlighted the role of faith in providing physical healing while Korean Americans saw the support of the religious community as the main benefit of their faith. Distrust of medicine was primarily articulated by members of African American churches. The results offer important implications for the future potential and nature of health initiatives in racial minority communities.     

A Review of Faith-Based HIV Prevention Programs

HIV disproportionately affects people of color, suggesting a need for innovative prevention programs and collaborations as part of prevention efforts. African Americans have close ties to the church and faith-based organizations. African American faith communities were slow to address HIV prevention, but in recent years, they have become more involved in such activities. This study reviews the empirical literature on faith-based HIV prevention programs among African American populations. Several successful faith-based/public health collaborations are identified, and the limitations and strengths of faith-based prevention programs are discussed. Recommendations are provided for developing effective faith-based/public health collaborations.

Where is the Faith? Using a CBPR Approach to Propose Adaptations to an Evidence-Based HIV Prevention Intervention for Adolescents in African American Faith Settings

African American adolescents are at increased risk for HIV/AIDS. Using a community-based participatory research approach, we engaged three black churches in adapting an evidence-based HIV prevention intervention, Focus on Youth (FOY)+ImPACT, for faith settings. To identify potential adaptations to increase FOY’s relevance, utility, and efficacy for faith settings, we conducted eight focus groups pre- and post-intervention. Recommendations for maintaining FOY’s core elements and enhancing its cultural authenticity include the following: incorporating faith tools, building pastor capacity, strengthening parent–child communication skills, and expanding social support for parents and youth. Engaging faith communities in adapting and implementing evidence-based HIV prevention programs could reduce HIV/AIDS disparities.     

A Qualitative Exploration of Religion,Gender Norms,and Sexual Decision-Making within African American Faith-Based Communities

Human immunodeficiency virus (HIV) continues to be a prominent health and social justice issue, especially for African American communities in the Southern United States. Gender role norms, specifically within faith-based communities in the South, pose challenges to empowering women to make safer sexual health decisions. To explore perceptions of gender norms and sexual health, 42 qualitative interviews were gathered from female members of 16 predominantly African American churches in Atlanta, GA. Constructs from the theory of gender and power and the social ecological model were used to guide coding and analysis. Participants discussed their experiences with gender norms and gender-based power differentials at the institutional (i.e., church), familial, and interpersonal (i.e., intimate relationship) levels. Because of the attitudes and beliefs held by their religious communities and families, many participants recalled struggling to assert themselves in sexual relationships and recalled engaging in risky and unwanted sexual behavior, especially during their young adult years. However, as the participants matured, they worked to overturn traditional gender norms, empowering both their children and women in their religious communities to make healthy, autonomous sexual decisions. Moving forward, participants want their churches and members of their faith communities to play an active role in the empowerment of African American women and provide them with the confidence and education necessary to negotiate sexual decisions with their partners.

     

Communicating HIV/AIDS Through African American Churches in North Carolina: Implications and Recommendations for HIV/AIDS Faith-Based Programs

This study explores HIV/AIDS communication strategies among church leaders at predominately African American churches in a metropolitan city and surrounding areas in North Carolina. The church leaders contacted for the study are members of an interfaith-based HIV/AIDS program. The researchers used semi-standardized interviews to explore how church leaders address HIV/AIDS in the church. The findings indicate that the seven church leaders who participated in the study use a variety of communication channels to disseminate HIV/AIDS information for congregants and their surrounding communities, which include both interpersonal and mass media.     

The specificity of maternal parenting behavior and child adjustment difficulties: a study of inner-city African American families.

The specificity of the association between 2 parenting behaviors (warmth and supervision) and 2 indicators, aggressive behavior and depressive symptoms, of major child outcomes (externalizing problems and internalizing problems) was examined among 196 inner-city African American mothers and their school age children. Given the growing number of African American families affected by HIV/AIDS and demonstrated compromises in parenting associated with maternal infection, the moderating role of maternal HIV/AIDS was also examined. Findings from longitudinal analyses supported the specificity of maternal warmth but not of maternal supervision. Maternal warmth was a stronger predictor of decreases in child aggressive behavior than of decreases in depressive symptoms. In addition, maternal warmth was a stronger predictor of decreases in aggressive behavior than was maternal supervision. Parenting specificity was not moderated by maternal HIV/AIDS. Clinical implications and future research directions are discussed.     

Pastor and Lay Leader Perceptions of Barriers and Supports to HIV Ministry Maintenance in an African American Church

Clergy and lay leaders have a pivotal role in the development and maintenance of HIV Ministries within the African American church. However, little is known about the actual roles these men and women have, the barriers they face and the supports they have found in the development and maintenance of an HIV Ministry. The purpose of this study is to examine the role, barriers and supports clergy and lay leaders experienced in the development of a long-standing HIV ministry in an African American church. These data were gathered from a larger ethnographic study, which examined the role of religious culture in the development, implementation and maintenance of an HIV ministry. Data for this study were collected through in-depth semi-structured interviews. Results revealed that the primary role of clergy and lay leaders involved dispelling myths surrounding HIV and ensuring congregational support. The primary barrier to the development and maintenance was views regarding sexuality. The primary support was their relationships with congregants that lived with HIV and AIDS. This information can assist in developing interventions to enhance the African American church movement toward HIV ministries.     

“Getting to Know”: Exploring How Urban African American Women Conceptualize Safer and Risky Sexual Behaviors

The surge in the rate of the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) cases continues to be most prevalent for African American women between the ages of 18 and 29, with heterosexual transmission remaining the primary cause of HIV spread for this population. The high rates of HIV/AIDS among African American women continue to emphasize the need for understanding how members of this population conceptualize sexual safety and risk. A qualitative research study using grounded theory methods was conducted to explore how African American women define safer and risky sexual behaviors. Interviews were conducted with 14 African American women between the ages of 18 and 29. The study findings suggest that African American women’s definitions of safer and risky sexual behaviors, while in a consensual sexual relationship, are consistently influenced by sex partner type. The information garnered from this study can help inform the development of HIV prevention strategies, health education, counseling and reproductive health services that support African American women’s wellness.     

Race,resource utilisation,and perceived need among urban community development workers from faith-based organisations

Organisations providing social services in communities of high crime and violence must address staff well-being. The current study surveyed 284 urban community development workers from faith-based organisations in five US cities. The study explored the effects of race and ethnicity on service utilisation and perceived need using binomial logistic regression. Race and ethnicity significantly predicted medical service utilisation, indicating that Caucasian participants were five times more likely and African-American participants were 3.8 times more likely than Latino/a participants to utilise medical services. Race and ethnicity did not predict differences in use of psychological or spiritual services, nor of perceived need for services. Furthermore, volunteer staffs were approximately four times more likely than paid staff to report self-addressing their psychological and spiritual needs rather than utilising services, despite a felt need for support. Barriers to resource utilisation and implications for policies and practices of urban community development organisations are discussed.     

What’s the 411? Assessing the Feasibility of Providing African American Adolescents with HIV/AIDS Prevention Education in a Faith-Based Setting

This study examines African American faith based leaders’ attitudes and beliefs about providing HIV prevention education and services to adolescents. Using a convenience sample, we identified priority adolescent health issues, attitudes about abstinence messages, and willingness to provide and participate in HIV prevention. Leaders identified drugs, gangs, alcohol, sex, and pregnancy as priority health issues affecting youth in their institutions. Leaders’ strongly preferred to emphasize abstinence messages. Although leaders were willing to provide youth with health education, they were not willing to discuss specific behaviors associated with HIV transmission. African American churches provide a venue to reach African American youth; however, there are limitations to relying on faith-based HIV prevention services. HIV prevention education should continue to be supplemented via parents, schools, and public health agencies.

Meaningful involvement of people living with HIV/AIDS in Uganda through linkages between network groups and health facilities: an evaluation study

While community-based groups are able to provide vital support to people living with HIV/AIDS (PLHIV), their organizational and technical capacities are limited, and they frequently operate in isolation from PLHIV groups. We evaluated a three-year project implemented by the International HIV/AIDS Alliance in Uganda to increase the involvement of PLHIV in the HIV/AIDS response and to improve access to and utilization of prevention, treatment, care, and support services for households affected by HIV/AIDS. Information sources included project monitoring data, interviews with 113 key informants, and 17 focus group discussions in 11 districts. The evaluation found that PLHIV groups reached large numbers of people with education and awareness activities and made a growing number of referrals to health facilities and community-based services. The project trained individuals living openly with HIV as service providers in the community and at designated health facilities. Their presence helped to reduce the stigma that previously deterred PLHIV from seeking care and encouraged individuals to disclose their HIV status to spouses and family members. The project has put into practice the widely endorsed principles of greater and meaningful involvement of PLHIV in a systematic manner and on a large scale. A wide audience--ranging from grassroots PLHIV networks and AIDS service organizations to national-level non-governmental organizations, government agencies, and international organizations--can benefit from the lessons learned.     

Reconceptualising hope within the context of vulnerability in South Africa

This study was aimed at clarifying conceptualisations of hope amongst vulnerable young people in a high HIV/AIDS prevalence South African setting. Participants were four young people ranging from 15 to 19, and interview data were collected on their household conditions, lived experiences in the communities and schools, and family support systems. Analysis applied grounded theory process to characterise main themes. Four mechanisms characterised the nurturing of hope processes in the context of vulnerability, namely: predatory, protective, promotion and possibility processes. Six protective intrapersonal themes were also identified: finding purpose, building a sense of the future; building faith in a higher power; embracing educational opportunities; thinking positively; building on strengths; and adopting supportive networks. Findings suggest that conceptualisations of hope need to be grounded in social context and the imperatives of social justice to support vulnerable young people in realising their future aspirations.     

“Big Momma Had Sugar,Imma Have It Too” Medical Fatalism and the Language of Faith Among African–American Women in Memphis

This essay offers a theological exploration of the relationship between medical fatalism and religious belonging among African–American women in Memphis. Drawing on the work of black and womanist theologians and on conversations with participants in a diabetes intervention program administered by a faith-based community health provider, I argue that how we narrate the meanings of our bodies is irreducibly religious. The language we use to interpret and communicate the meaning of our bodily existence emerges from a set of assumptions, often unarticulated, about what is of ultimate value to us. The essay focuses on three interlocking features that link faith with fatalism or hope: (1) The idea that if “I don’t claim that” disease cannot enter my body; (2) the role of faith-based clinics in re-establishing trust with marginalized communities; and (3) how nuanced attention to the social location of health seekers can re-frame our understanding of patient compliance. Disrupting fatalism can only be done from within a health seeker’s own narrative, and therefore, healthcare providers who learn these narratives and respect their holiness will develop more effective interventions.     

The equivalence of the Child Behavior Checklist/1 1/2-5 across parent race/ethnicity, income level, and language

This study examined the equivalence of the Child Behavior Checklist/1 1/2-5 (CBCL/1 1/2-5) in 682 parents of 2- to 4-year-old children stratified by parent race/ethnicity (African American, Latino, and non-Latino White), family income (low vs. middle-upper), and language version (Spanish vs. English). Externalizing Scale means differed by income and child gender. Internalizing Scale means differed by income and parent race/ethnicity. Differential item analyses showed that few items functioned differently by racial/ethnic, language, and income group. A confirmatory factor analysis demonstrated that the Externalizing Scale provided a good fit with the data across racial/ethnic and income groups. However, model fit was improved for the Internalizing Scale when factor weights were allowed to vary. Findings support the equivalence of the CBCL/1 1/2-5 when used with parents of low-income preschool children from African American and Latino backgrounds, although further study of the factor structure for the Internalizing Scale is recommended.     

A Systematic Comparison of African American and Non-African American Patients on Psychosocial Aspects of Hepatitis C Infection

The purpose of this study was to compare African American and non-African American hepatitis C virus (HCV) patients on self-reported symptoms of HCV liver disease and psychosocial characteristics commonly affected by it in a sample of 309 patients enrolled in a randomized controlled trial. African Americans (n = 196) rated a higher reliance on religion/spirituality for coping with HCV compared to non-African Americans. This study’s findings are a basis for encouragement of public health efforts and programs to seek partnerships with African American faith and religious communities to identify and treat undiagnosed cases of HCV and promote HCV awareness.     

School adjustment of adolescents affected by HIV and AIDS: A case study

The study examined the school adjustment of South African adolescents affected by HIV and AIDS . Participants were a convenient sample of 60 adolescents from a secondary school in a major South African city (females = 73 .33%, 50% affected by HIV and AIDS, grade 8 = 40%, grade 9 = 30%, grade 10 = 30%, age range = 16–18 years) . Data on their personal functioning were gathered using the Beck Youth Inventory^TM and the Enhanced School Support Inventory (ESSI) . The data analysis comprised between-group and within-group comparisons, using the t-test statistic . Findings suggest that adolescents affected by HIV and AIDS had significantly lower psychological and behavioural functioning than their typical other peers . Results also show that these affected learners had lower school adjustment than their typical peers . The schools environment can support comprehensive interventions to addresses psychosocial vulnerability among adolescents affected by HIV and AIDS .     

Being Examples to the Flock: The Role of Church Leaders and African American Families Seeking Mental Health Care Services

Within the context of Black churches, African American clergy have a significant role in the delivery of mental health care services for parishioners and their families. Working toward better linkages between faith-based communities and more formal mental health care could help to provide more culturally sensitive and timely mental health care for African American families. Using a salient part of an integrative model (Davey and Watson in Contemp Fam Ther 30:31–47, 2008), the roles Black church leaders have historically played for African American families seeking outside mental health care services are considered. We additionally provide an example of a recent collaborative partnership with a Black church that points toward some promising directions for future research and clinical collaborations between the field of couple and family therapy and the Black church community.     

Correlates of spirituality and well-being in a community sample of people living with HIV disease

While the past several years have witnessed an increase in the amount of research examining the spiritual perspectives of people living with HIV/AIDS, this literature is still insufficient to guide the conceptualization and development of spiritually based interventions to improve the life quality of people living with HIV illness. The present study assessed a community sample of 275 persons living with HIV disease to examine relationships among their spirituality, quality of life, perceptions of social support, and coping and adjustment efforts. This study found relationships between social support, active problem solving, life satisfaction, and gender and race with higher levels of spirituality among people living with HIV/AIDS. Mental health providers may need to routinely include assessments of spirituality and religious practices. Caregivers, faith communities, and mental health providers will need to assist in developing supportive environments that enhance the spiritual life and social well-being of people living with HIV infection. Additionally, caregiver training programs will need to focus on spiritual practices as a means of establishing a support system that increases the psychosocial well-being of people living with HIV/AIDS.     

Utilizing Community Partnerships to Devise a Framework for Cultural Adaptations to Evidence-Based Mental Health Practice in Diverse Communities

Mental health disparities for diverse communities (particularly immigrants and people of color) in terms of access to evidence-based treatments, lack of education/awareness about mental health symptoms and treatment options, and lack of culturally responsive treatments have been frequently documented. Hence, diversity considerations in the diagnosis, assessment, and treatment of psychological disorders remain vital and imperative in clinical practice. There is also substantial work indicating that cultural values likely play an essential role in shaping how individuals conceptualize and experience mental or emotional health. Therefore, the present study was developed for community-engaged clinicians and researchers to outline the process by which to create a culturally responsive, evidence-based treatment framework for community mental health interventions in close partnership with communities of color. This study was conceptualized and designed collaboratively with community leaders across five different communities of color: African American/Black, Latino/a, Native American, Pacific Islander, and African immigrant communities in a major U.S. city. This paper describes the mixed methods for such a community-engaged collaboration, highlighting critical elements for ongoing culturally engaged clinical work/research, and providing recommendations for culturally adapted interventions for mental health based on specific process observations made in the current example.