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Erma Lawson, RN, PhD and Azzie Young, PhD, MPA

At the time this article was written, Erma Lawson was with the Division of Public Health Practice, Harvard University School of Public Health, Boston, Mass. Azzie Young is with the Mattapan Community Health Center, Mattapan, Mass.

Correspondence: Requests for reprints should be sent to Erma Lawson, RN, PhD, Department of Sociology, University of North Texas, PO Box 311157, Denton, TX 76201 (e-mail: elawson{at}scs.cmm.unt.edu).

	ABSTRACT

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In a Black community in Boston, Mass, a community health center developed a faith-based initiative to improve the health of community residents. In partnership with a steering committee composed of community health advocates, church leaders, and community leaders, the community health center planned and implemented annual Health Care Revival meetings at which screening activities and dissemination of health information are integrated with inspirational singing and scripture readings.

The success of the Health Care Revival initiative is demonstrated by an increased use of community health center services after each revival meeting, by participants' evaluations, and by an increase in the number of community health improvement projects begun as a direct result of the Health Care Revival initiative.

	INTRODUCTION

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THE MATTAPAN COMMUNITY Health Center (MCHC) and a community steering committee developed the Health Care Revival (HCR) initiative to empower a Black community to engage in a dialogue about its health. The HCR initiative was created in 1997 to address the health disparities of residents in Mattapan, a Boston, Mass, community where residents experience high age-adjusted mortality rates. For example, rates of breast, prostate, and colorectal cancer; cardiovascular and infant mortality; and AIDS incidence and mortality are higher in Mattapan than elsewhere in Boston. Additionally, Mattapan experiences a persistent influx of new Caribbean immigrants with serious neglected health problems. A large number of Mattapan's children and senior citizens live below the poverty level.

The HCR initiative is a faith-based, data-driven community partnership that occurs within a context that renews vision, rekindles commitment, and revives the spirit. The term "revival" is especially significant because Blacks share a religious tradition, dating to Africa, in which the sacred and secular are inseparable. The use of White middle-class outreach strategies and risk assessment research in Black communities often leads to simplistic behavioral interventions that do not incorporate spiritual reawakening or revival.^1–3

	PLANNING THE HCR INITIATIVE

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The executive director of the MCHC organized a community steering committee of community health advocates, church leaders, and community leaders to assist MCHC in addressing the health needs of the Mattapan community. The steering committee supports and is involved in every aspect of the HCR initiative: planning and implementing the annual HCR meeting, debriefing and priority-setting based on feedback from the event, and implementing community health improvement projects. During the planning of the HCR initiative, the steering committee and MCHC held bimonthly meetings.

The first step in planning the initiative was a review of neighborhood data from the Boston Public Health Commission, data from the Mattapan Community Health Center's database, and findings from a survey of Mattapan's teenagers. Second, the importance of spirituality was acknowledged. Faith often provides comfort to Blacks within the context of social and economic marginality. Third, there was intensive publicity about the health data and the HCR event. This publicity included mailings to Mattapan residents, radio and television announcements, and door-to-door canvassing. Flyers announcing the HCR were placed in Mattapan's retail establishments, and the MCHC and community steering committee encouraged nonprofit health agencies to announce the HCR in their newsletters.

	THE REVIVAL MEETINGS

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The free annual HCR meetings are held under tents in September on the first Saturday after Labor Day; approximately 300 Mattapan residents and friends participate. There are 4 large tents: a health information and screening tent, a children's tent, and 2 tents for the main activities. A mammography van and a pediatric dental van are also present. Free child care and lunches are provided.

The HCR meeting is a combination Southern revival meeting and community health fair. It consists of inspirational singing, survivor testimonies, dissemination of health information, and screening. The meeting begins at 9:30 AM and ends at 3:00 PM. The inclusion of ministers, inspirational singers, and prayers throughout the day highlights the integration of the faith-based components with health outreach strategies. Box 1 shows an example of the HCR program.

Box 1 —Example of HCR Program HEALTH CARE REVIVAL PROGRAM Welcoming Remarks and Devotion 9:30–10:00 am Registration, Inspirational Music, Continental Breakfast Inspirational Beginning Singing Scripture Prayer Singing Community Call to Action 10:25–10:30 am Introduction of Keynote Speaker Singing, Culture Jam 10:35–11:05 am Keynote Speaker 11:10–11:45 am Testimonials by Cancer survivors and survivors of other chronic diseases (i.e. Lupus) Singing, Culture Jam 11:50–12:05 pm Question & Answer Awards Ceremony 12:10 pm Entertainment Teen Choir 12:30 pm Community Service Award Lunch, Singing, Networking 12:45–1:15 pm Lunch (Provided) Entertainment: Culture Jam Networking 1:30–2:40 pm Discussion Groups Building Our Future 2:45–3:00 pm Inspirational Reconvening and Singing Report Back: Discussion Group Reporters Wrap-up and Next Steps 3:00 pm Spiritual Benediction Song and Prayer Benediction

 

Morning activities include welcoming remarks and a devotion led by a member of a faith-based organization that underscores a holistic approach to a healthy mind, body, and spirit. A gospel choir sings and a Bible scripture is read. A keynote speaker presents information on the health status of the Mattapan community, integrating a spiritual philosophy toward encouraging preventive health care. Survivors of cancer and chronic diseases present moving testimonies. An interactive question and answer period follows, during which professionals and community leaders provide national, state, and local health information.

During the midday session, a Community Service Award is presented to acknowledge an individual who has devoted his or her time to improving the health of the community. Consistent with the revival theme, inspirational and gospel music are played while the participants network and eat lunch.

View larger version (111K): [in this window] [in a new window]   Revival attendees sit under the big tent in Mattapan, a community in Boston, Massachusetts.

Box 2 —Examples of Health Care Revival Discussion Groups Group Members: Facilitator, In all Groups Staff Resource Recorder Reporter Resource Persons Discussion Group 1 Focus: Getting Real with Teen Health Purpose: Real world strategies to improve teens' health in Mattapan and Hyde Park Topics: Nutrition, physical activity, and social wellness Discussion Group 2 Focus: Prevention, Detection and Management of Lupus and Cancers Purpose: Learn prevention, detection, and management methods and treatment options Topics: Prevention, strategies, detection methods, and management strategies Discussion Group 3 Focus: Prevention and Management Strategies for Diabetes Purpose: Strategies for preventing and managing diabetes and its complications Topics: Systems of care, community resources and strategies

 

The HCR meeting ends with reports from the discussion groups to the larger audience, a presentation of next steps to improve the health status of Mattapan, and a summing up (i.e., take-away messages). The summing up is followed by a spiritual benediction, singing, and prayer led by the HCR faith-based coordinator, who is a minister.

	DISCUSSION AND EVALUATION

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Evaluating the full impact of a faith-based health outreach strategy is difficult. We used several strategies to monitor the effectiveness of the HCR initiative. First, by monitoring MCHC use, we found that after each HCR meeting there was an increase in use of services at MCHC. Second, we asked participants to evaluate the effectiveness of the meeting. Almost all of the participants (95%) reported that after the HCR meeting they felt they were better informed about health issues in the Mattapan community and about MCHC services.

Community health improvement projects generated by the afternoon discussion groups serve as another evaluation measure. The current number of such projects indicates the success of the HCR. These projects focus on infant survival, adolescent health, and breast cancer awareness. MCHC and the community steering committee implement community health improvement projects throughout the year. For instance, on the basis of feedback from the HCR, MCHC implemented a comprehensive health program for teenagers, including a health clinic and an intensive community campaign to encourage early and continuous prenatal care, which reduced the infant mortality rate in Mattapan.

The follow-up and momentum generated by the HCR are also demonstrated by 2 reports. The Blueprint for Action report identifies strategic goals addressing the health of Mattapan's residents. These goals include community health education, community outreach, and community collaboration. The Blueprint for Action has been distributed to Mattapan residents and surrounding communities. The Teen Health Plan report, distributed in 1999, served as a guide for MCHC's teen health program.

	FUNDING AND COSTS

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Boston Medical Center and Brigham and Women's Hospital and Partners HealthCare System largely funded the HCR initiative for the first 3 years. MCHC and grants have funded the initiative since that time. Direct costs include tent and audio equipment rentals; purchase of snacks and lunches; the costs of health education materials, translation services, mass mailings, printing, and publicity campaigns; consultants' fees; child care costs; and expenses for invited program participants. Considerable in-kind donations are made by MCHC, including staff at all levels, consisting of program promotion, setting up of equipment, participation in the program, and subcontracting for a record of the revivals. These costs will vary by region for those replicating this project.

	NEXT STEPS

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HCR meetings provide a vehicle for sharing health information, providing health screening, engaging the community in a dialogue about its health, and initiating community partnerships to address the community's health needs within a faith-based context. The next event, based on evaluations and comments from participants in previous meetings, will focus on the prevention of cancer among Black men.

The inspirational activities of the HCR initiative—prayer, singing, and scripture readings—reinforce the importance of integrating the mind, body, and spirit to improve the health of the Mattapan community.

	HIGHLIGHTS

TOP ABSTRACT INTRODUCTION PLANNING THE HCR INITIATIVE THE REVIVAL MEETINGS DISCUSSION AND EVALUATION FUNDING AND COSTS NEXT STEPS HIGHLIGHTS References

 

• The Health Care Revival initiative is a new faith-based outreach strategy for Black communities.
  
• Health Care Revival meetings provide a vehicle to share health information, provide health screening, and empower Black communities to address their health needs.
  
• Community feedback provides an ongoing opportunity to set an agenda for the improvement of community health.
  

	Acknowledgments

 
The HCR initiative has been funded in part by Mattapan Community Health Center; Boston Medical Center; Brigham and Women's Hospital and Partners HealthCare System; the Massachusetts Department of Public Health; the US Department of Health and Human Services, Bureau of Primary Health Care; and the Harvard Division of Public Health Practice.

We acknowledge the contributions of Mattapan Community Health Center's board and staff, the community steering committee, the Reverend Lena Hill-Lawrence, Marian Knapp, Dr Peter Gorski, Bruce Smith, Morning Star Baptist Church, Simmons College, Soldiers of Health, the WellChild Foundation, the Boston Public Health Commission, and other community partners.

	Footnotes

 
E. Lawson wrote the paper. A. Young conceptualized the HCR initiative, and developed the framework for the HCR meetings.

Peer Reviewed

Accepted for publication January 28, 2001.

	References

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1. Thomas VG. Explaining health disparities between African-American and white populations: where do we go from here? J Natl Med Assoc. 1992;84:837–840.[Medline]

2. Lawson E, Rodgers-Rose L. Social correlates of Black women's health status. In: Staples R, ed. The Black Family: Essays and Studies. 6th ed. Belmont, Calif: Wadsworth Publishing Co; 2000:320–331.

3. Ganz M. The relationship between external threats and smoking in Central Harlem. Am J Public Health. 2000; 90:367–371.[Abstract/Free Full Text]

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