title: The Effect of Changes in Health Beliefs Among African-American and Rural White Church Congregants Enrolled in an Obesity Intervention: A Qualitative Evaluation.
abstract: Church interventions can reduce obesity disparities by empowering participants with knowledge and skills within an established community. The purpose of this study was to evaluate the Biomedical/Obesity Reduction Trial (BMORe) and investigate changes in health beliefs among obese adult participants. Ten pre-/post-intervention focus groups applying the Health Belief Model conducted in two African-American churches in Tennessee (n = 20) and South Carolina (n = 20), and one rural Appalachian church in Kentucky (n = 21). Two independent coders using NVivo analyzed transcribed audio data and notes. Participants' health status of being overweight/obese and having comorbidities of diabetes and high blood pressure motivated enrollment in BMORe. Initially participants voiced low self-efficacy in cooking healthy and reading food labels. BMORe made participants feel "empowered" after 12 weeks compared to initially feeling "out of control" with their weight. Participants reported improvements in emotional health, quality of life, and fewer medications. During post-intervention focus groups, participants reported increased self-efficacy through family support, sharing healthy eating strategies, and having accountability partners. Solidarity and common understanding among BMORe participants led focus group attendees to comment how their peers motivated them to stay in the program for 12 weeks. Long-term barriers include keeping the weight off by maintaining habits of exercise and healthy eating. Implementation of pre-/post-intervention focus groups is an innovative approach to evaluate an obesity intervention and track how changes in health beliefs facilitated behavior change. This novel approach shows promise for behavioral interventions that rely on participant engagement for sustained effectiveness.
authors.affiliation: Department of Prevention and Community Health, The Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA. Dmartinez15@gwu.edu.
authors.forename: Diane J
authors.initials: DJ
authors.lastname: Martinez
authors.affiliation: Department of Prevention and Community Health, The Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA.
authors.forename: Monique M
authors.initials: MM
authors.lastname: Turner
authors.affiliation: The George Washington University, GW Cancer Institute, Washington, DC, 20036, USA.
authors.forename: Mandi
authors.initials: M
authors.lastname: Pratt-Chapman
authors.affiliation: The George Washington University, GW Cancer Institute, Washington, DC, 20036, USA.
authors.forename: Kanako
authors.initials: K
authors.lastname: Kashima
authors.affiliation: Meharry Medical College, Nashville, TN, 37208, USA.
authors.forename: Margaret K
authors.initials: MK
authors.lastname: Hargreaves
authors.affiliation: Department of Internal Medicine, University of Kentucky, Lexington, KY, 40536, USA.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Dignan
authors.affiliation: Department of Epidemiology and Biostatistics and Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, 29208, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Hébert
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D007629:Kentucky; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000208:ethnology / Q000523:psychology / Q000628:therapy; D050177:Overweight / Q000523:psychology; D036301:Qualitative Research; D011788:Quality of Life; D012067:Religion; D012424:Rural Population; D013022:South Carolina; D013714:Tennessee; D044465:White People; D055815:Young Adult
keywords: African-Americans; Health knowledge, attitudes, practice; Obesity; Rural health