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Mark J. DeHaven, PhD, Irby B. Hunter, MD, Laura Wilder, MLS, James W. Walton, DO and Jarett Berry, MD

Mark J. DeHaven, Irby B. Hunter, Laura Wilder, and Jarett Berry are with the University of Texas Southwestern Medical Center at Dallas. James W. Walton is with the Baylor Health Care System, Dallas.

Correspondence: Requests for reprints should be addressed to Mark J. DeHaven, PhD, Division of Community Medicine, Department of Family Practice and Community Medicine, University of Texas Southwestern Medical Center at Dallas, 6263 Harry Hines Blvd, Dallas, TX 75390-9067 (e-mail: mark.dehaven{at}utsouthwestern.edu).

	ABSTRACT

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Objectives. We examined the published literature on health programs in faith-based organizations to determine the effectiveness of these programs.

Methods. We conducted a systematic literature review of articles describing faith-based health activities. Articles (n = 386) were screened for eligibility (n = 105), whether a faith-based health program was described (n = 53), and whether program effects were reported (28).

Results. Most programs focused on primary prevention (50.9%), general health maintenance (25.5%), cardiovascular health (20.7%), or cancer (18.9%). Significant effects reported included reductions in cholesterol and blood pressure levels, weight, and disease symptoms and increases in the use of mammography and breast self-examination.

Conclusions. Faith-based programs can improve health outcomes. Means are needed for increasing the frequency with which such programs are evaluated and the results of these evaluations are disseminated.

	INTRODUCTION

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There is a sizable multidisciplinary literature describing the health-related activities of religious or faith-based organizations (FBOs). Studies have described the features of successful health promotion programs and partnerships in churches^1,2 and the importance of the church as an ally in efforts to provide preventive health and social services to at-risk populations.³ In addition, the interconnections between public health, health education, and FBOs have been examined,⁴ and the possible contributions of FBOs to improved community health outcomes have been described.⁵

A development related to health programs offered by FBOs is the need for improving access to care for the 43 million nonelderly uninsured adults residing in the United States. It has been shown that uninsured individuals are more likely than those with insurance coverage to avoid seeking needed care, to have been hospitalized for a preventable condition, and to have been diagnosed with advanced-stage cancer.⁶ Proposals for expanding health insurance coverage focus on increasing the role of government⁷ and generally ignore the role played by nonfunded health care providers in providing access to care. Especially important for public health practitioners is whether faith-based health programs can, for example, provide predictable and measurable health benefits in the communities they serve.⁸

FBOs have a long history of independently and collaboratively⁹ hosting health promotion programs in areas such as health education,^1,10 screening for and management of high blood pressure¹¹ and diabetes,¹² weight loss¹³ and smoking cessation,¹⁴ cancer prevention and awareness,^15–17 geriatric care,¹⁸ nutritional guidance,¹⁹ and mental health care.²⁰ However, little is known about the effectiveness of these programs. Nonfunded health programs are not part of an organized system of care and are sometimes considered "nonsystems of care."²¹ However, if such programs provide consistent access to specific types of care for specific individuals, they may actually be delivering predictable—but unmeasured—community health benefits.

A study was undertaken to review the health programs in FBOs and to examine their effectiveness. The Working Group on Human Needs and Faith-Based and Community Initiatives notes that the current vocabulary surrounding discussions of "faith-based" organizations tends to "confuse and divide."²² The term FBO evokes images ranging from store-front churches, to the YMCA, to the local chapter of Habitat for Humanity. In the present article, the term FBO is used as a catch-all category referring to health programs designed, conducted, or supported by groups affiliated with or based in a nonsecular setting.

The National Congregations Study revealed that about 57% of US congregations participate in various social service delivery programs, including food and clothing, housing and homelessness, domestic violence, substance abuse, employment, and health programs.²³ In the present study, we examined the health activities of FBOs only or those activities specifically related to health promotion/disease prevention. Also, we examined the published literature on FBO health programs in an attempt to ascertain the effectiveness of these programs. Successful programs are likely to be overrepresented in such a review, which is consistent with our study intent: we were not concerned with presenting an exhaustive review of social service activities in FBOs; rather, we intended this study as a first step in determining the possible contribution of health programs to maintaining or improving the health of individuals in the communities they serve.

	METHODS

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Literature Review and Search Strategies
We conducted a systematic qualitative review of health-related databases for the years 1990 through 2000.²⁴ This 10-year period was selected by consensus among the authors on the belief that a "faith and health movement"²⁵ occurred in the 1990s. Another reason we selected this period is that faith–health collaborations represent a rapidly developing phenomenon, and the results of a preliminary search indicated the existence of a large body of literature available during the period. The purpose of the review was to identify all published English-language research articles reporting the health activities of FBOs. Our search strategies were guided by a preliminary review of the literature, and the searches were conducted by one of the authors, who is a professional research librarian (L. W.).

We chose MEDLINE as our major database and, because there were no existing medical subject headings specific enough for our topic, we devised a comprehensive search strategy. Our strategy involved the use of a set of indexing terms related to health service delivery, such as health promotion, health education, counseling, and screening. These terms were combined with a second set of text words (e.g., parish, congregation, faith based, community church) describing where the health services might be delivered.

We performed supplemental searches of the HealthSTAR, CINAHL, and PsycINFO databases. In the case of HealthSTAR, we created and combined 3 groups of terms: health service terms, religion terms and phrases, and diagnosis and therapy terms. The CINAHL search consisted of identifying articles including one of 3 phrases—faith based, church based, or parish based—or either parish nursing or congregational nursing. We used 2 alternative strategies in the search of the PsycINFO database. The first focused on the phrases faith based and church based, since the phrase parish based was not useful in this database; the second focused on a group of religion terms and a separate group of community mental health service terms.

All articles (n = 386) meeting the search criteria were reviewed by 1 of the investigators (M. J. D.) for possible inclusion in the present study. Titles and abstracts were examined for consistency with our objective of identifying health programs involving FBOs. In cases in which abstracts were not available, determinations were made on the basis of title alone. If the title did not provide a clear indication of the article’s content, the article was obtained before a determination was made regarding inclusion or exclusion. After evaluation of the search results, 106 articles^{1–4,9–20,26–115} were identified for formal review.

The formal review consisted of reading an article to ensure that it addressed a specific, identifiable health program that could be linked to a specific health benefit. The following types of articles were excluded: articles discussing the existence of a program without describing its features, articles discussing a "healing ministry" without describing a specific program, and review articles describing a collection of programs without providing details about individual programs. In addition, articles were excluded when the church building was being used for a multisite program developed as part of a broader public health strategy (however, articles were included if the church or congregation was an active member of a communitywide health coalition). Once these articles were excluded, 53 articles remained.

Data Gathering
Information was recorded about program features and outcomes, including location (city and state), scope (congregation, community, city, or region), number of congregations involved, target population (age and ethnicity), target conditions, and program objective (primary, secondary, or tertiary prevention). Objectives were coded as primary when the program was designed to increase awareness of disease, secondary when the goal was risk reduction, and tertiary if treatment was involved. When more than 1 type of prevention activity was involved, the objective of the majority of program activities was recorded. When a program qualified for more than 1 program scope area, the code for the largest geographic scope was entered.

Programs were categorized according to FBO level of involvement, whether program outcomes were measured, and number of participants. Almost all programs evaluated were based in a church or congregation, as opposed to an interfaith service organization, temple, or mosque, consistent with the finding of Chaves et al.¹¹⁶ that only about 3.5% of all social services are delivered in non-Christian settings. Determining level of church involvement was essential since most analysts agree that collaboration is necessary for the success of faith-based health and community programs.^30,51,52,73 Church involvement was coded as "faith placed" if health professionals used the church to test an intervention and "faith based" if the program was part of the church’s health ministry. Programs were coded as "collaborative" if they combined faith-placed and faith-based features.

In instances in which no clinical outcomes were reported, we used process measures. When only number of client contacts was reported, we did not include this information in our measurements because it was not related to possible health benefits. Finally, we recorded total number of participants, including experimental controls and, in the case of multiple-year programs, individuals participating in all years of the program. When program outcomes were reported, articles were evaluated by 2 investigators, and disputes over coding content were resolved through discussion.

In the following, we report descriptive statistics, including percentages and measures of central tendency and dispersion. We conducted all analyses using SPSS version 10.0. We used ² tests of independence in examining relationships between categorical variables.

	RESULTS

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Health programs were conducted in 30 distinct geographic locations, either counties or cities. Although most locations hosted 1 program, 5 cities accounted for approximately one third of the total number of programs: Chicago (n = 6; 11.3%), Baltimore (n = 4; 7.5%), Los Angeles (n = 4; 7.5%), Cleveland (n = 2; 3.8%), and Oakland (n = 2; 3.8%). Programs were located in 23 different states, but almost half (n = 26) were located in 5 states: California (n = 8; 15.1%), Illinois (n = 6; 11.3%), Maryland (n = 5; 9.4%), Ohio (n = 4; 7.5%), and Florida (n = 3; 5.7%).

The majority of programs were directed at congregation members (60.4%) or the surrounding community (24.5%) (Table 1). Although more than 40% of the programs involved a single congregation, the median number of participating congregations was 3 (range = 1–95), and the number of program participants ranged from 7 to 2519 (median = 238). Most programs focused on primary prevention (50.9%), usually patient education, in the area of general health maintenance (24.5%), cardiovascular health (20.7%), or cancer (18.9%). Approximately one third of the programs did not target a specific population (32.1%); however, when a population was targeted, it tended to be African American (41.5%) and adult (43.4%). The overwhelming majority of programs did not involve a specific target in terms of gender (75.5%).

All 4 of the faith-based programs included in the sample reported intervention effects, and these programs addressed heart disease (25%), mental illness (50%), and asthma (25%). In both of the studies demonstrating significant effects, validated instruments showed decreased mental illness symptoms.^104,105 The number of participants was small, ranging from 7 to 46 (median = 24).

Of the 6 collaborative programs, 5 (83.4%) reported program intervention effects on general health (40%), weight/nutrition (40%), and smoking cessation (20%). Outcomes were evaluated via self-report and biological measures,¹⁸ validated instruments,¹⁹ and biological measures.¹³ Significant effects included improvements in overall health status, increases in fruit/vegetable consumption, and decreases in weight and blood pressure. These programs ranged in size from 30 to 966 participants (median = 133), and the programs were almost exclusively (80%) directed toward African Americans.

	DISCUSSION

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In this study, we reviewed FBO health programs and assessed their effectiveness. Our objective was to take a first step toward determining whether these types of programs can provide a measurable form of community-based care. The first conclusion offered by our review is that relatively little information exists on which to base assessments of the effectiveness of such programs. Although our literature search identified a substantial number of articles (n = 386) possibly related to our study objective, fewer than 1 in 3 (n = 106; 27.5%) were eligible for the review, and even fewer (n = 53; 13.7%) actually discussed a specific program. Finally, only a small number of articles presented outcome measures (n = 28; 7.25%) or outcome measures associated with a particular program intervention (n = 20; 5.4%).

The data presented here nonetheless demonstrate that faith-based health programs can produce positive effects; for example, they can significantly increase knowledge of disease, improve screening behavior and readiness to change, and reduce the risk associated with disease and disease symptoms. According to the Bureau of Primary Health Care Faith Partnership Initiative, which seeks to facilitate partnerships between FBOs and health providers, there are 43 million uninsured citizens in the United States, it is not known how to meet the health-related needs of this group, there are more churches per capita in the United States than in any other country, and faith communities are involved in public health and community development issues related to social justice.⁸ Our findings suggest a number of recommendations for future study if FBOs are to contribute to community health in the ways envisioned by the Faith Partnership Initiative.

Recommendation 1: Increase collaboration between FBOs and health professionals for the purpose of evaluating health activities and disseminating findings. Disproportionately more is known about the effectiveness of faith-placed programs than either faith-based or collaborative programs. In the present study, we found that 55% of the programs testing interventions were faith placed, 20% were faith based, and 25% were collaborative.

As many as 57% to 78% of congregations are involved in health activities.^23,117 By increasing collaboration between health professionals and faith-based groups, it may be possible to introduce evaluation strategies into programs and to disseminate the results to a wider audience. Researchers and other health professionals should consider developing user-friendly workshops and tools for use by individuals associated with FBOs that are accustomed to delivering but not evaluating health-related programs. Since FBOs and churches are familiar community-based institutions, they frequently succeed when outside health professionals cannot.¹¹⁸ More thorough collaboration between researchers and FBOs will facilitate better understanding of the community on the part of these health professionals, contribute to building the credibility of their projects,^3,119 and, we hope, promote increased program evaluation.

Recommendation 2: Place more emphasis on effectiveness studies as opposed to efficacy studies. Efficacy studies test the effects of interventions regardless of their practical application, whereas effectiveness studies test interventions in a way that is sensitive to what is practical in the real world. Efficacy studies generally require a more sophisticated study design, a greater amount of funding, and a greater degree of commitment and control than is typically available in most community-based settings. Consequently, they may be difficult to replicate in most congregations, especially in a way that could reliably contribute to a community’s health.

In the present study, 7 of the 15 intervention studies reporting significant findings involved either a quasi-experimental^53,112 or an experimental^{12,16,39,104,106} design, and all but 1 of these interventions were classified as faith placed. We suggest the use of study designs that are concerned with the quality of the care delivery system as opposed to more sophisticated designs that may be beyond the expertise of local program planners and difficult to implement in their care setting. Continuous Quality Improvement efforts and "Plan–Do–Study–Act" cycles, with their emphasis on process of care, systematic methods, short cycles, and real-world application, offer more accessible and manageable approaches to evaluating programs in these community-based settings.^120,121

Recommendation 3: Devote more attention to building relationships with the racially and ethnically diverse populations that increasingly characterize communities in the United States. When a target population was identified in the present study, it tended to be African American (41.5%), and most of the faith-placed intervention programs (91%) were directed toward African American populations. This finding is not surprising since, in a majority of African American communities, the church is considered the most important social institution³⁶ and is the key community agent linking the African American community to the wider society beyond the congregation.⁵¹ In addition, African American churches can reach large numbers of individuals in the communities outside of their particular congregations¹¹⁴ and can sponsor community activities for all of those in need.^73,103

It is important to both continue and to expand the work that is currently being done in African American communities among the many successful and progressive faith–health partnerships. However, we must also recognize that there are significant needs in other racial and ethnic groups, especially Hispanics. Although non-Hispanic Whites represent approximately half of all uninsured individuals, African Americans and Hispanics, respectively, are twice as likely and 3 times as likely as non-Hispanic Whites to be uninsured.¹²² As previously mentioned, uninsured individuals are more likely than those with insurance coverage (1) to forgo or postpone preventive care and skip recommended tests or treatments,¹²³ (2) to be hospitalized for conditions that can be treated in outpatient settings (e.g., uncontrolled diabetes), and (3) to be diagnosed with late-stage colorectal cancer, melanoma, breast cancer, and prostate cancer.¹²⁴ Given the types of health services offered through FBOs, increased collaboration between health professionals and FBOs serving Hispanic populations could potentially improve quality of life in this vulnerable group.

The present study and the recommendations offered help provide a better conceptualization and understanding of the extent of existing information, our need for more information, and possible directions for future collaboration between public health professionals and those providing health services through FBOs. Despite the different perspectives of these 2 groups, they tend to share a passionate commitment to improving the quality of life of vulnerable populations. If faith and health partnerships can help address the existing and expected health needs of vulnerable populations, more thorough information about their possible contribution is needed to make informed policy decisions. Only by increasing the evaluation component of faith-based programs and disseminating the information gained will it be possible to determine how these programs can contribute systematically to improving the health and quality of life of at-risk populations in our communities.

	Acknowledgments

 
We are grateful for the capable and timely assistance with article preparation provided by Shannon Lee, Division of Community Medicine, University of Texas Southwestern Medical Center at Dallas. We also thank Jan Rookstool for her assistance in study coordination.

Human Participant Protection
No protocol approval was needed for this study.

	Footnotes

 
Contributors
M. J. DeHaven developed the idea, original conceptualization, and design for this study. I. B. Hunter contributed to developing the initial idea, performed reviews of the literature, and assisted with article preparation. L. Wilder developed the literature search strategies, performed the searches, and assisted with reviewing the literature. J. W. Walton and J. Berry assisted with the final review of the included studies, helped to reconcile appropriate categorization of programs, and reviewed final versions of the article.

Peer Reviewed

Accepted for publication January 21, 2003.

	References

TOP ABSTRACT INTRODUCTION METHODS RESULTS DISCUSSION References

 
1. Hatch J, Derthick S. Empowering black churches for health promotion. Health Values Achieving High Level Wellness. 1992;16(5):3–9.

2. Sanders EC. New insights and interventions: churches uniting to reach the African American community with health information. J Health Care Poor Underserved.1997;8:373–375.[ISI][Medline]

3. Sutherland M, Hale CD, Harris GJ. Community health promotion: the church as partner. J Primary Prev.1995;16:201–217.

4. Chatters LM, Levin JS, Ellison CG. Public health and health education in faith communities. Health Educ Behav.1998;25:689–699.[Abstract]

5. Foege WH, O’Connell U. Healthy People 2000: A Role for America’s Religious Communities. Chicago, Ill: Park Ridge Center and Carter Center; 1990.

6. Schroeder SA. Prospects for Expanding health insurance coverage. N Engl J Med.2001;344:847–852.[Free Full Text]

7. Feder J, Levitt L, O’Brien E, Rowland D. Covering the low-income uninsured: the case for expanding public programs. Health Aff. 2001;20:27–39.

8. Baird LJ. Spirituality and faith in health care delivery. Community Health Center Manage. 1999;33:24–26.

9. Thomas SB, Quinn SC, Billingsley A, Caldwell C. The characteristics of northern black churches with community health outreach programs. Am J Public Health. 1994;84:575–579.[Abstract/Free Full Text]

10. Wilson LC. Implementation and evaluation of church-based health fairs. J Community Health Nurs.2000;17:39–48.[Medline]

11. Smith ED, Merritt SL, Patel MK. Church-based education: an outreach program for African Americans with hypertension. Ethn Health.1997;2:243–253.[Medline]

12. McNabb W, Quinn M, Kerver J, Cook S, Karrison T. The PATHWAYS church-based weight loss program for urban African-American women at risk for diabetes. Diabetes Care.1997;20:1518–1523.[Abstract]

13. Kumanyika SK, Charleston JB. Lose weight and win: a church-based weight loss program for blood pressure control among black women. Patient Educ Counseling.1992;19:19–32.[ISI][Medline]

14. Schorling JB, Roach J, Siegel M, et al. A trial of church-based smoking cessation interventions for rural African Americans. Prev Med.1997;26:92–101.[ISI][Medline]

15. Earp JA, Flax VL. What lay health advisors do: an evaluation of advisors’ activities. Cancer Pract.1999;7:16–21.[ISI][Medline]

16. Duan N, Fox SA, Derose KP, Carson S. Maintaining mammography adherence through telephone counseling in a church-based trial. Am J Public Health.2000;90:1468–1471.[Abstract/Free Full Text]

17. Davis DT, Bustamante A, Brown CP, et al. The urban church and cancer control: a source of social influence in minority communities. Public Health Rep. 1994;109:500–506.[ISI][Medline]

18. Cowart ME, Sutherland M, Harris GJ. Health promotion for older rural African Americans: implications for social and public policy. J Appl Gerontol.1995;14:33–46.[Abstract/Free Full Text]

19. Barnhart JM, Mossavar-Rahmani Y, Nelson M, Raiford Y, Wylie-Rosett J. Innovations in practice: an innovative, culturally-sensitive dietary intervention to increase fruit and vegetable intake among African American women: a pilot study. Top Clin Nutr. 1998;13:63–71.

20. Jensen CA, Flynn S, Cozza MA, Karabin J. Including the ultimate: a spiritual focus treatment program in an inpatient psychiatric area of a hospital in partnership with a pastoral counseling center. J Pastoral Care. 1998;52:339–348.[Medline]

21. Ferrer RL. Within the system of no-system. JAMA. 2001;286:2513–2514.[Free Full Text]

22. Finding common ground: 29 recommendations of the Working Group on Human Needs and Faith-Based and Community Initiatives. Available at: http://www.working-group.org. Accessed January 10, 2002.

23. Chaves M, Tsitsos W. Congregations and social services: what they do, how they do it, and with whom. NonProfit Voluntary Sector Q.2001;30:660–683.

24. Cook DJ, Mulrow CD, Haynes RB. Systematic reviews: synthesis of best evidence for clinical decisions. Ann Intern Med. 1997;126:376–380.[Abstract/Free Full Text]

25. Engaging Faith Communities as Partners in Improving Community Health. Atlanta, Ga: Centers for Disease Control and Prevention; 1999.

26. Abrums M. "Jesus will fix it after awhile": meanings and health. Soc Sci Med. 2000;50:89–105.

27. Parish nursing at St. Michael: when the congregation is 17,000 strong and growing. Perspect Parish Nurs Pract. 1998;1:3–6.

28. Atkins FD. What should the church do about health? J Christian Nurs. 1997;14(1):29–31.

29. Bailey PL. Social work practice with groups in the church context: a family life ministry model in an inner-city church. Soc Work Groups.1993;16:55–67.

30. Baker EA, Homan S, Schonhoff R, Kreuter M. Principles of practice for academic/practice/community research partnerships. Am J Prev Med.1999;16(suppl 3):93.

31. Baker S. HIV/AIDS, nurses, and the black church: a case study. J Assoc Nurses AIDS Care. 1999;10(5):71–79.[Medline]

32. Boario MT. Mercy model: church-based health care in the inner city. J Christian Nurs. 1993;10(1):20–22.

33. Boehm S, Coleman-Burns P, Schlenk EA, Funnell MM, Parzuchowski J, Powell IJ. Prostate cancer in African American men: increasing knowledge and self-efficacy. J Community Health Nurs. 1995;12:161–169.[Medline]

34. Boland CS. Parish nursing: addressing the significance of social support and spirituality for sustained health-promoting behaviors in the elderly. J Holistic Nurs.1998;16:355–368.

35. Brown-Hunter M, Price LK. The Good Neighbor Project: volunteerism and the elderly African-American patient with cancer. Geriatr Nurs.1998;19:139–141.[ISI][Medline]

36. Bronner YL. Session II wrap-up: community-based approaches and channels for controlling hypertension in blacks: barriers and opportunities. J Natl Med Assoc.1995;87:652–655.[Medline]

37. Brunner SL. Collaborative efforts support poor elderly: a nursing center teams up with area churches to care for the elderly in their homes. Health Prog. 1994;75(7):46–48.

38. Burkhart L. Choosing the right outcome measurement system to capture parish-nursing practice. Perspect Parish Nurs Pract. Fall–Winter 1999:2.

39. Campbell MK, Demark-Wahnefried W, Symons M, et al. Fruit and vegetable consumption and prevention of cancer: the Black Churches United for Better Health Project. Am J Public Health.1999;89:1390–1396.[Abstract/Free Full Text]

40. Canda ER, Phaobtong T. Buddhism as a support system for Southeast Asian refugees. Soc Work. 1992;37:61–67.

41. Castro FG, Elder J, Coe K, et al. Mobilizing churches for health promotion in Latino communities: Companeros en la Salud. J Natl Cancer Inst Monogr.1995;18:127–135.

42. Chase-Ziolek M, Striepe J. A comparison of urban versus rural experiences of nurses volunteering to promote health in churches. Public Health Nurs.1999;16:270–279.[ISI][Medline]

43. Collins M. Increasing prostate cancer awareness in African American men. Oncol Nurs Forum.1997;24:91–95.[Medline]

44. Cook C. Faith-based health needs assessment: implications for empowerment of the faith community. J Health Care Poor Underserved.1997;8:300–301.[ISI][Medline]

45. Delafield D. Southeast Christian Church Counseling Ministry: One church’s model for ministering to those in need. J Psychol Christianity. 1997;16:148–153.

46. Demark-Wahnefried W, Hoben KP, Hars V, Jennings J, Miller MW, McClelland JW. Utility of produce ratios to track fruit and vegetable consumption in a rural community: church-based 5 a day intervention project. Nutr Cancer.1999;33:213–217.[ISI][Medline]

47. Denny MS. Church-based geriatric care. Nurs Adm Q.1990;14(2):64–67.[Medline]

48. DeSchepper C. Healthier communities through parish nursing: a South Dakota system finds multiple ways to support parish nursing programs. Health Prog.1999;80(4):56–58.

49. Dixon S. Parish nurse ministry improves health outcomes of low-income community. Aspens Advisor Nurse Executives. 1996;11(11):7–8.

50. Easton KL, Andrews JC. Nursing the soul: a team approach. J Christian Nurs. 1999;16(3):26–29.

51. Eng E, Hatch J, Callan A. Institutionalizing social support through the church and into the community. Health Educ Q.1985;12:81–92.[ISI][Medline]

52. Eng E, Hatch JW. Networking between agencies and black churches: the lay health advisor model. Prev Hum Serv.1991;10:23–46.

53. Erwin DO, Spatz TS, Stotts RC, Hollenberg JA. Increasing mammography practice by African American women. Cancer Pract.1999;7:78–85.[ISI][Medline]

54. Ferdinand KC. The Healthy Heart Community Prevention Project: a model for primary cardiovascular risk reduction in the African-American population. J Natl Med Assoc. 1995;87(suppl 8):638–641.[Medline]

55. Ferdinand KC. Lessons learned from the Healthy Heart Community Prevention Project in reaching the African American population. J Health Care Poor Underserved. 1997;8:366–371.[ISI][Medline]

56. Flack JM, Wiist WH. Cardiovascular risk factor prevalence in African-American adult screenees for a church-based cholesterol education program: the Northeast Oklahoma City Cholesterol Education Program. Ethn Dis. 1991;1:78–90.[Medline]

57. Ford ME, Edwards G, Rodriguez JL, Gibson RC, Tilley BC. An empowerment-centered, church-based asthma education program for African American adults. Health Soc Work.1996;21:70–75.[ISI][Medline]

58. Fox SA, Stein JA, Gonzalez RE, Farrenkopf M, Dellinger A. A trial to increase mammography utilization among Los Angeles Hispanic women. J Health Care Poor Underserved.1998;9:309–321.[ISI][Medline]

59. Gerber JC, Stewart DL. Prevention and control of hypertension and diabetes in an underserved population through community outreach and disease management: a plan of action. J Assoc Acad Minor Phys.1998;9(3):48–52.[Medline]

60. Gunderson GR. Religious congregations as factors in health outcomes. J Med Assoc Ga.1998;87:296–298.[Medline]

61. Harding DJ, Southern J. Using a community networking approach in a bereavement program. Am J Hosp Palliat Care.1991;8(4):20–22.[Abstract/Free Full Text]

62. Harper DP. Angelical conjunction: religion, reason, and inoculation in Boston, 1721–1722. Pharos Alpha Omega Alpha Honor Med Soc.2000;63:37–41.[Medline]

63. Hirano D. Partnering to improve infant immunizations: the Arizona Partnership for Infant Immunization (TAPII). Am J Prev Med.1998;14:22–25.[ISI][Medline]

64. Holschneider CH, Felix JC, Satmary W, Johnson MT, Sandweiss LM, Montz FJ. A single-visit cervical carcinoma prevention program offered at an inner city church: a pilot project. Cancer.1999;86:2659–2667.[ISI][Medline]

65. Huggins D. Parish nursing: a community-based outreach program of care. Orthop Nurs.1998;17(2):26–30.[Medline]

66. Jackson AL. Operation Sunday School—educating caring hearts to be healthy hearts. Public Health Rep.1990;105:85–88.[ISI][Medline]

67. Jackson RS, Reddick B. The African American church and university partnerships: establishing lasting collaborations. Health Educ Behav.1999;26:663–674.[Abstract/Free Full Text]

68. Joel LA. Parish nursing: as old as faith communities. Am J Nurs.1998;98:7.

69. Johnson GA. Recapturing a vision: lay counseling as pastoral care. J Psychol Christianity.1997;16:132–138.

70. Kaufmann MA. Wellness for people 65 years and better. J Gerontol Nurs.1997;23(6):7–9.

71. Kiser M, Boario M, Hilton D. Transformation for health: a participatory empowerment education training model in the faith community. J Health Educ. 1995;26:361–365.

72. Kutter CJ, McDermott DS. The role of the church in adolescent drug education. J Drug Educ.1997;27:293–305.[ISI][Medline]

73. Lasater TM, Becker DM, Hill MN, Gans KM. Synthesis of findings and issues from religious-based cardiovascular disease prevention trials. Ann Epidemiol.1997;7(suppl 7):S46–S53.

74. Lashley ME. Congregational care: reaching out to the elderly. J Christian Nurs.1999;16(3):14–16.[Medline]

75. Lenehan GP. Free clinics and parish nursing offer unique rewards. J Emerg Nurs.1998;24:3–4.[Medline]

76. Lloyd JJ, McConnell PR, Zahorik PM. Collaborative health education training for African American health ministers and providers of community services. Educ Gerontol.1994;20:256–276.

77. Lough MA. An academic-community partnership: a model of service and education. J Community Health Nurs.1999;16:137–149.[Medline]

78. McDermott MA, Solari-Twadell PA, Matheus R. Promoting quality education for the parish nurse and parish nurse coordinator. Nurs Health Care Perspect.1998;19:4–6.[ISI][Medline]

79. McRae MB, Carey PM, Anderson-Scott R. Black churches as therapeutic systems: a group process perspective. Health Educ Behav.1998;25:778–789.[Abstract]

80. McRae MB, Thompson DA, Cooper S. Black churches as therapeutic groups. J Multicultural Counseling Dev.1999;27:207–220.

81. Morgan L. Faith meets health: religious congregation, outside agencies join to promote public health. Healthweek (Texas). 1999;4(18):15.

82. Mustoe KJ. The unbroken circle: parish nursing is becoming an important stage in the healthcare continuum. Health Prog. 1998;79(3):47–49.[Medline]

83. Nelson BJ. Parish nursing: holistic care for the community. Am J Nurs. 2000;100(5):24.

84. Oexmann MJ, Thomas JC, Taylor KB, et al. Short-term impact of a church-based approach to lifestyle change on cardiovascular risk in African Americans. Ethn Dis.2000;10:17–23.[Medline]

85. Ofili E, Igho-Pemu P, Bransford T. The prevention of cardiovascular disease in blacks. Curr Opin Cardiol.1999;14:169–175.[ISI][Medline]

86. Okwumabua JO, Martin B, Clayton-Davis J, Pearson CM. Stroke Belt Initiative: the Tennessee experience. J Health Care Poor Underserved.1997;8:292–299.[ISI][Medline]

87. Penner SJ, Galloway-Lee B. Parish nursing: opportunities in community health. Home Care Provider.1997;2:244–249.[Medline]

88. Phillipp ML. Teaching the hungry to fish: group helps inner-city neighborhood help itself. Health Prog.1997;78(4):52–53.[Medline]

89. Porter EJ, Ganong LH, Armer JM. The church family and kin: an older rural black woman’s support network and preferences for care providers. Qual Health Res.2000;10:452–470.[Abstract/Free Full Text]

90. Ransdell LB. Church-based health promotion: an untapped resource for women 65 and older. Am J Health Promotion.1995;9:333–336.[ISI][Medline]

91. Riordan RJ, Simone D. Codependent Christians: some issues for church-based recovery groups. J Psychol Theology.1993;21:158–164.

92. Roque F, Walker L, Herrod P, Pyzik T, Clapp W. The Lawndale Christian Health Center Asthma Education Program. Chest. 1999;116(suppl 1):201S–202S.[Free Full Text]

93. Ruesch AC, Gilmore GD. Developing and implementing a healthy heart program for women in a parish setting. Holistic Nurs Pract.1999;13(4):9–18.

94. Rydholm L. Patient-focused care in parish nursing. Holistic Nurs Pract.1997;11(3):47–60.

95. Schumann R. Parish nursing: a call to integrity. J Christian Nurs. 2000;17(1):22–23.[Medline]

96. Schuster SJ. Wholistic care: healing a "sick" system. Nurs Manage. 1997;28(6):56–59.

97. Smith ED. Hypertension management with church-based education: a pilot study. J Natl Black Nurses Assoc. 1992;6:19–28.[Medline]

98. Solari-Twadell PA. The caring congregation: a healing place. J Christian Nurs.1997;14(1):4–9.

99. Stillman FA, Bone LR, Rand C, Levine DM, Becker DM. Heart, body, and soul: a church-based smoking-cessation program for urban African Americans. Prev Med.1993;22:335–349.[ISI][Medline]

100. Stoy DB, Curtis RC, Dameworth KS, et al. The successful recruitment of elderly black subjects in a clinical trial: the CRISP experience. J Natl Med Assoc.1995;87:280–287.[Medline]

101. Stuchlak P. Toning the temple: a church-based health fair. J Christian Nurs. 1992;9(3):22–23.

102. Stuckey JC. The church’s response to Alzheimer’s disease. J Appl Gerontol. 1998;17:25–37.[Abstract/Free Full Text]

103. Taylor RJ, Ellison CG, Chatters LM, Levin JS, Lincoln KD. Mental health services in faith communities: the role of clergy in black churches. Soc Work. 2000;45:73–87.[ISI][Medline]

104. Toh YM, Tan SY. The effectiveness of church-based lay counselors: a controlled outcome study. J Psychol Christianity.1997;16:263–267.

105. Toh YM, Tan SY, Osburn CD, Faber DE. The evaluation of a church-based lay counseling program: some preliminary data. J Psychol Christianity. 1994;13:270–275.

106. Voorhees CC, Stillman FA, Swank RT, Heagerty PJ, Levine DM, Becker DM. Heart, body, and soul: impact of church-based smoking cessation interventions on readiness to quit. Prev Med.1996;25:277–285.[ISI][Medline]

107. Wahking H. The problems and the glory in church related counseling. J Psychol Christianity.1997;16:161–167.

108. Weinrich SP, Boyd MD, Bradford D, Mossa MS, Weinrich M. Recruitment of African Americans into prostate cancer screening. Cancer Pract. 1998;6:23–30.[ISI][Medline]

109. Weiss R. Serving the community: beyond medical care. Health Prog. 1992;73(9):60–62.

110. Wenzel DR, Thomsen M. A multidenominational Christian counseling center. J Psychol Christianity. 1997;16:115–120.

111. Whisnant S. The parish nurse: tending to the spiritual side of health. Holistic Nurs Pract. 1999;14:84–86.

112. Wiist WH, Flack JM. A church-based cholesterol education program. Public Health Rep. 1990;105:381–388.[ISI][Medline]

113. Williams DR, Griffith EEH, Young JL, Collins C, Dodson J. Structure and provision of services in black churches in New Haven, Connecticut. Cultural Diversity Ethnic Minority Psychol. 1999;5:118–133.

114. Winett RA, Anderson ES, Whiteley JA, et al. Church-based health behavior programs: using social cognitive theory to formulate interventions for at-risk populations. Appl Prev Psychol. 1999;8:129–142.

115. Turner LW, Sutherland M, Harris GJ, Barber M. Cardiovascular health promotion in North Florida African-American churches. Health Values. 1995;19(2):3–9.

116. Chaves M, Konieczny ME, Kraig B, Barman E. The National Congregations Study: background, methods, and selected results. J Sci Study Religion. 1999;38:458–460.[ISI]

117. Hilton D. Some models of church health ministry in the USA. Available at: http://www.interaccess.com/iphnet/hilton2txt.htm. Accessed July 19, 2000.

118. Public Health Service. Churches as an Avenue to High Blood Pressure Control. Washington, DC: US Dept of Health and Human Services; 1989.

119. Randall-David E. Strategies for Working With Culturally Diverse Communities and Clients. Bethesda, Md: Association for the Care of Children’s Health; 1989.

120. Langley AE, Maurana CA, LeRoy GL, et al. Developing a community academic health center: strategies and lessons learned. J Interprofessional Care.1998;12:273–277.

121. Spernoff T, Miles P, Mathews B. Improving health care, part 5: applying the Dartmouth clinical improvement model to community health. J Qual Improvement. 1998;24:679–703.

122. Institute of Medicine. Coverage matters: insurance and health care. Available at: http://www.iom.edu/uninsured. Accessed September 15, 2001.

123. Henry J. Kaiser Foundation. Medicaid and the uninsured. Available at: http://www.kff.org/content/2002/142003/. Accessed January 5, 2002.

124. Uninsured in America: A Chart Book. Washington, DC: Kaiser Commission on Medicaid and the Uninsured; 2000.

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