Health promoting behaviors among African American women with faith-based support

ABNF Journal, The, Sept-Oct, 2004 by Shirlee Drayton-Brooks, Neva White

Abstract: The purpose of his qualitative exploratory study was to document health perceptions, beliefs and attitudes, intentions and social pressures that influence health promoting behaviors as expressed by community level aggregates of African American women with faith support. Twenty-six African American women from two large urban congregations with an active health ministry program participated in this study. Focus group interviews guided by the Theory of Planned Behavior (Ajzen & Fishbein, 1980 & 1991) were used to identify salient health perceptions, beliefs and attitudes, intentions, and social pressures influencing health-promoting behaviors in African American women with faith-based support. Positive health perceptions, attitudes, and beliefs were identified as important to engaging in a healthy lifestyle. Exercise, well balanced diets, weight reduction and stress management were the most salient health concerns among the respondents. Key referents identified included the pastor, congregational nurses, physicians, and church/ family members. Control beliefs among these women reflected salient spiritual and fatalistic beliefs concerning health-promoting behaviors. Trusting relationships, open communication, safe, comfortable, and familiar environments were identified as important considerations when planning health promotion interventions for an African American faith community. Conclusions: Health beliefs, attitudes, and behaviors are not developed outside of social systems, therefore, the facilitation of healthy lifestyle behaviors may be best assessed and influenced within a context of reciprocal social interaction such as in a faith-based community. In the context of a community level aggregate with faith-based support, behaviors to promote a healthy lifestyle may be positively influenced.

Key Words: Health Beliefs, Health Attitudes, Health Promoting Behaviors, African American Women, Faith-based Health Promotion, Focus Group Interviews, Theory of Planned Behavior.

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According to Healthy People 2010, African Americans account for only 12% of the population in the United States, yet African Americans, as a group, have the poorest health status indicators in the nation and are disproportionately represented among underserved populations (USDHHS, 2002). Fifty-five percent (55%) of the 33.9 million African Americans in this country are women (USDHHS, 1995). Although there have been improvements in mortality rates, heart disease, stroke, and obesity, the health status of African American women continue to lag behind their white counterparts (DHHS, 1995). African Americans continue to be two times more likely than whites to have hypertension, obesity, and high fat intake. Poor nutrition, smoking, alcohol, and drug abuse are reported to occur commonly in African American women thereby increasing the risk for heart disease and type 2 diabetes. The lack of access to preventative care, a stressful lifestyle, poor education, inadequate housing, low paying jobs, and a lack of insurance are powerful predictors of health outcomes (Bailey, 1987; Davis & Curley, 1999). The major health disparities among many racially and ethnically diverse people with low incomes is ample evidence of the lack of access to health care and an ongoing dire need for improved health access and health promotion in these communities (Drayton-Hargrove & Woods, 1995).

Research on health promoting lifestyles has focused on individual choice with little attention to sociocultural (Palank, 1999) and environmental factors (Morgan & Marsh, 1998). Informed individual choice may be a simple explanation for health promoting behaviors, but complex processes influencing health behaviors such as cultural interpretations, group specific attitudes, and environmental context must be further examined (Ahijevych & Bernhard, 1994; Briscoe & Pichert, 1996; Drayton-Hargrove & White, 1999; Flaskerud & Winslow, 1998; Glanville & Porche, 1998; Jennings-Dozier, 1999; Palank, 1999).

Development of partnerships and investigations related to health promotion within a social system such as faith communities with the goal to improve health outcomes of community level aggregates can serve to facilitate improvements in health status indicators in the areas of social support, mental health, nutrition, exercise, smoking cessation among venerable at-risk populations (Van Olphen, Shultz, Israel, Chatters, Klem, Parker & Williams, 2003; Resinicow, Jackson, Wang, De, McCarty, Dudley, & Baranowski., 2001;.Resnicow, Jackson, Braithwaite, Dilorio, Blisset, Rahotep & Periasamy, 2002; Stillman, Bone, Rand, Levine, & Becker, 1993; Wiist & Flack, 1990).

Focus group interviews have been employed as a method for creating partnerships with African American women (Drayton-Hargrove & White, 1999; Pletsch, Doerr, & Irwin, 2001). According to Fishbein, Bandura, Triandis, Kanfer, Becker, and Middlestadt (1991), prior to attempting to develop any fixed item assessment instrument, a standardized elicitation procedure and/or focus groups should be used with the population for whom the instrument is intended.