title: Lessons learned in community research through the Native Proverbs 31 Health Project.
abstract: BACKGROUND
  American Indian women have high rates of cardiovascular disease largely because of their high prevalence of hypertension, diabetes, and obesity. This population has high rates of cardiovascular disease-related behaviors, including physical inactivity, harmful tobacco use, and a diet that promotes heart disease. Culturally appropriate interventions are needed to establish health behavior change to reduce cardiovascular disease risk.
  
  
  OBJECTIVE
  This study was conducted in Robeson County, North Carolina, the traditional homeland of the Lumbee Indian tribe. The study's goal was to develop, deliver, and evaluate a community-based, culturally appropriate cardiovascular disease program for American Indian women and girls.
  
  
  METHODS
  Formative research, including focus groups, church assessments, and literature reviews, were conducted for intervention development. Weekly classes during a 4-month period in 4 Lumbee churches (64 women and 11 girls in 2 primary intervention churches; 82 women and 8 girls in 2 delayed intervention churches) were led by community lay health educators. Topics included nutrition, physical activity, and tobacco use cessation and were coupled with messages from the Proverbs 31 passage, which describes the virtuous, godly woman. Surveys collected at the beginning and end of the program measured programmatic effects and change in body mass index.
  
  
  RESULTS
  Churches were very receptive to the program. However, limitations included slow rise in attendance, scheduling conflicts for individuals and church calendars, and resistance to change in cultural traditions.
  
  
  CONCLUSIONS
  Churches are resources in developing and implementing health promotion programs in Christian populations. Through church partnerships, interventions can be tailored to suit the needs of targeted groups.
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Kimes
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Golden
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Rhonda F
authors.initials: RF
authors.lastname: Maynor
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: John G
authors.initials: JG
authors.lastname: Spangler
authors.affiliation: Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: rbell@wakehealth.edu.
authors.forename: Ronny A
authors.initials: RA
authors.lastname: Bell
mesh_terms: D000293:Adolescent; D000328:Adult; D002835:Christianity; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods; D006801:Humans; D007198:Indians, North American; D009657:North Carolina; D012907:Smoking; D016540:Smoking Cessation; D012944:Social Support
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