Health Ministry Activities in Omaha Area Congregations Kay Ryan, RN, Ph.D. 1, JoAnn Eickhoff-Shemek, Ph.D. 2, Reverend Daniel Johnston, B.A. 3 1 Nebraska Methodist College; 2 University of Nebraska at Omaha; 3 Methodist Health System, Omaha, Nebraska Corresponding author: Kay Ryan, RN, PhD, Chairperson of Health Promotions, Nebraska Methodist College 8501 West Dodge, Omaha, NE 68114; phone: 402.354.4953; fax: 402.354.8875; email: KRYAN@METHODISTCOLLEGE.EDU Article submitted January 4, 2001; revised and accepted July 5, 2001 Abstract This study investigated the perceptions of church/synagogue leaders regarding their involvement in congregational health promotion in the Omaha area. The study utilized a written, mail-out/mail-back survey. Of the 654 mailed surveys, 41% were returned. The data were analyzed to determine the level of intervention of reported health promotion programs based on the adapted O Donnell model. The results seem to indicate that those congregations offering health promotion programs are doing so at high levels of intervention. Introduction Faith communities have a long history of caring about the health of their members. The Health and Religion Project found that Churches were particularly receptive to participate in health promotion programming for their congregants (Lasater, Wells, Carleton & Elder, 1986). Ransdell (1995) pinpoints the belief that spiritual and physical health are highly related and this explains why church-based health promotion is successful. A number of studies exist that attest to the efficacy of church-based health promotion programs in reaching the members of our communities who have little or no access to health promotion activities (Briscoe & Pichert, 1996; Ransdell, 1995; Smith, 1992; Turner, Sutherland, Harris & Barber, 1995). As stated in Healthy People 2010, Places of worship may be a particularly important setting for health promotion initiatives and they may effectively reach some underserved populations (U.S. Department of Health and Human Services, 2000, p. 7-6). Little research has been conducted to determine the overall scope of church-based health promotion programs. The purpose of this study was to investigate the perceptions of church/synagogue leaders regarding their involvement in congregational health promotion in the Omaha metropolitan area. Program administration factors and the four levels of intervention based on the adapted O Donnell model were obtained to describe health promotion/health ministry activities (Storlie, Baun & Horton, 1992). The four levels of intervention according to the adapted O Donnell model are: 1) Communication and Awareness, 2) Screening and Assessment, 3) Education and Lifestyle, and 4) Behavior Change Support Systems. Although all four http://www.iejhe.org levels of intervention are important, levels three and four have been shown most likely to produce positive organizational health outcomes such as decreased health care utilization, increased productivity, and decreased absenteeism. Procedures The two-page instrument used for this study was a survey developed by the authors entitled the Health Promotion/Health Ministries Survey (HPHMS). It was a modified version of a survey used to assess worksite health promotion programs in the Omaha area (Eickhoff-Shemek & Ryan, 1995). A panel of experts from health promotion and health ministry fields operationalized the terms for the instrument. The first page contained 11 questions regarding demographics and administration features of health promotion/health ministry activities such as staffing, stage of maturity, and reasons for involvement. The panel of experts identified a list of health promotion/health ministry activities for each of the four levels of intervention utilizing the adapted O Donnell model (Storlie, Baun, & Horton, 1992). Page two of the instrument consisted of the four lists of activities with instructions to check all activities that have been conducted in the congregation in the past two years. The survey was pilot tested for content and face validity by a panel of health promotion professionals and pastors. Modifications were made in response to feedback. The reliability of the survey was determined using test-retest response comparisons. The instrument was reliable because responses were the same. The cover letter that accompanied the survey defined health promotion/health ministry activities as the ways that congregations attend to the health of their members

with focus on the whole person, pertaining to physical, mental and spiritual well-being. The population of the Omaha metropolitan area is approximately 650,000. The sample was comprised of the entire listing of all churches/synagogues (N=654) in the Omaha metropolitan area. The American Business List Company donated the mailing list. The cover letter and survey were mailed to the lead pastor of each church/synagogue. A revised cover letter and the survey instrument were re-mailed to non-respondents. Results A total of 267 surveys were returned for a response rate of 41%. Descriptive statistics were used to present the findings. Demographic results are presented in Table 1. Forty-three percent of the respondents came from Catholic, Lutheran, or United Methodist congregations and 68% of the respondents represented congregations with less than 500 members. Table 1. Demographic Factors Gender: n % Male 152 57% Female 68 26% Unanswered 47 17% Denomination: Catholic 40 15% Lutheran 39 15% United Methodist 35 13% Presbyterian 25 9% Baptist 22 8% Other 106 40% Size of Congregation: 0-99 57 21% 100-249 84 32% 250-499 41 15% 500-749 23 9% 750-999 8 3% 1000-2499 22 8% 2500+ 24 9% Unanswered 8 3% Table 2 presents the data on program administration factors. Of the 267 respondents, a total of 128 (47.9%) indicated they offered a health promotion/health ministry program at the beginning (25.5%), growth (20.2%), or advanced (2.2%) stage of maturity. Forty (15%) of the 267 respondents claimed to have a health promotion/health ministry committee. The top reasons chosen for involvement in health promotion/health ministry activities were response to holistic view of life (ranked first) and community outreach/service (ranked second). Forty-three (16%) of the total respondents had a designated person to oversee the health promotion/health ministry program at their church/synagogue. Of these, eight (19%) were paid staff, 24 (56%) were volunteers, and 11 (25%) did not answer the question. All 32 paid staff and volunteers indicated that they possessed a degree or diploma in nursing or a health-education/health promotion related field and 19 of the 32 (59%) reported spending less than ten hours per week coordinating health promotion/health ministry activities. Evaluation of the health promotion/health ministries programs was reportedly conducted in 8% (n=22) of the congregations. Frequencies and percentages of the types of health promotion activities offered are presented in Table 3. These data are divided into the four levels of intervention: 1) communication and awareness, 2) screening and assessment, 3) education and lifestyle, and 4) behavior change support systems (Storlie et al., 1992). The most prevalent programs offered were: Level 1 - Information on domestic abuse Health information provided regularly through bulletin, newsletter, etc. Level 2 - Blood pressure checks Flu shots Level 3 - Premarital counseling Retreats for youth Level 4 - Programs that enhance spiritual health Marital counseling support As demonstrated in Table 3, the highest reported activities in levels one and two were 32% (information on domestic abuse - level one) and 16% (blood pressure checks - level two). However, respondents indicated much higher activity in levels three and four than in levels one and two. For example, the top four activities reported under educational and lifestyle (level three) http://www.iejhe.org 319

and the top seven activities reported under behavior change/support systems (level four) exceeded the most prevalent activity in levels one and two. Discussions The purpose of this study was to investigate the status of health promotion/health ministry activities in Omaha area churches/synagogues. There are several limitations to this study. First, the low response rate (41%) may have limited the results of this study in terms of accurately representing churches/synagogues in the Omaha, Nebraska area. A number of strategies were employed to obtain a higher response rate, including postcard reminders, telephone calls, and survey/cover letter re-mailing. One reason that the response rate was lower than expected may be that if no structured health promotion programs were in place, pastors may have felt there was no need to complete the survey. Second, the survey relied on self-report data which can also affect the accuracy of the results. Third, the entire listing of Omaha area churches/synagogues was used for the survey sample. Omaha churches/synagogues may not be representative of churches/synagogues in other communities. Of the 267 respondents, 128 (48%) indicated that their church/synagogue was involved in offering health promotion/health ministry activities and specified a stage of maturity for the program but only 43 (16%) claimed to have a designated person to oversee the program. Most of these designees were volunteers that would be typical in congregations, where many committees are coordinated by and consist of volunteers. Many of the designated people who oversaw the programs reported adequate preparation/qualifications for heading up a health promotion program. The top two reasons for conducting health promotion/health ministry activities were response to holistic view of life and community outreach/service. These reasons reflect the general mission of most churches/synagogues. In contrast, many traditional health promotion efforts have focused on improving the physical health of individuals. Regarding the levels of intervention of health promotion/health ministry activities, it was found that level three and level four activities were more commonly offered than levels one and two. This phenomenon was especially notable given that it occurred primarily at levels three and four which are Table 2. Program Administration Factors 1. What stage of maturity would you n = 267 % rate your Health Promotion/Health Ministry activities? Non existent 95 35.6 Beginning (early conceptual stage) 68 25.5 Growth (offering programs/planning 54 20.2 expansion) Advanced (well established, 6 2.2 comprehensive programming) No Answer 44 16.5 2. Does your church have a Health Promotion/Health Ministry committee? Yes 40 15 No 216 81 No Answer 11 4 3. Ranking of the top reasons for involvement in health promotion. Respondents checked their top five reasons. Response to holistic view of life 77 (mind-body-spirit) Community outreach/service 72 Improve individual health 67 Promoting personal responsibility for 56 individual health Creating healthier families 49 Expression of good stewardship 47 Improve level of congregation s 42 health Good personal discipline 26 Support for positive behavior change 25 Attract new members to congregation 21 Generates enthusiasm for life 20 A tool to help manage stress 17 Social interaction of members 17 Other 8 4. Do your have a person who oversees the church s health promotion/health ministry program? Yes 43 16 No 181 68 No Answer 43 16 5. If yes, is this person paid or volunteer? Paid Staff 8 19 Volunteer 24 56 No Answer 11 25 6. Has your church conducted any evaluation efforts of benefits of Health Promotion/Health Ministry? Yes 22 8 No 160 60 No Answer 85 32 http://www.iejhe.org 320

Table 3. Frequencies and Percentages for Each Level of Intervention (Respondents Checked All Items That Applied) N=267 LEVEL 1 Communication and Awareness n % Information on domestic abuse 85 32 Health information provided regularly through bulletin, newsletter, etc. 79 30 Violence information 71 27 Stress management information in newsletters, bulletins 69 26 Emotional/mental health information in newsletter, bulletin, etc. 64 24 Recycling information or recycling programs at church 62 23 Provide HIV/AIDS information 49 18 Cancer prevention information 46 17 Health themes on certain days of year 40 15 Nutrition information in newsletter, bulletin, etc. 39 15 Exercise information in newsletter, bulletin, etc. 32 12 Recognizing those who serve in health care 30 11 Information on safety (bicycle, home, etc.) 30 11 LEVEL 2 Screening and Assessment Blood pressure checks 43 16 Flu shots 30 11 Organizational profile (For example, demographics of church members) 22 8 Member interest survey 19 7 Visiting nurses program 19 7 Health fairs 18 7 Health risk appraisal 17 6 Nutrition classes 15 6 Cholesterol screening 12 5 Wellness inventory (evaluation of lifestyle behaviors/beliefs without assessing health 9 3 risk) Cancer screenings 7 3 Fitness testing 7 3 Health history questionnaire 5 2 Physical or medical exams 4 2 Mental health screenings 1 <1 LEVEL 3 Educational and Lifestyle Premarital counseling 175 66 Retreats for youth 147 55 Youth group programs which address drugs, dating, intimacy, pregnancy, etc. 131 49 Parenting classes 90 34 Retreats for adults 74 28 Intergenerational programs of all types (elderly and youth, adopting nursing home 60 22 residents, etc.) Stress management workshops 35 13 Emotional/mental health classes 26 10 Fitness classes 23 9 Safety programs (bicycle, home, etc.) 20 7 Smoking cessation 13 5 Self defense classes 5 2 Provide prenatal birthing classes 3 1 LEVEL 4 Behavior Change Support Systems Programs that enhance spiritual health (bible study, prayer groups, etc.) 183 69 Marital counseling/support 159 60 Food pantries, meal programs, meals on wheels 150 56 No smoking policy 139 52 Special offerings to assist people in need 134 50 Volunteers to assist the sick, shut ins 132 49 Volunteers to take elderly and ill to doctors, hospitals, etc. 95 36 Healing services 74 28 Support groups (cancer, divorce, parenting, active singles, grief, HIV/AIDS) 68 25 Day care/preschool center for children 64 24 Alcoholics anonymous 63 24 Emotional/mental health counseling 54 20 Healthy foods are regularly provided as options at functions (fruit, bagels, etc.) 51 19 Parenting support groups 41 15 Groups making or donating medical supplies 38 14 Hospice program involvement 20 7 Day care for elders 6 2 generally found to have the greatest impact on positive organizational health outcomes of health promotion programs (Storlie et al., 1992). The findings of this study are in direct contrast to worksite findings (Eickhoff-Shemek & Ryan, 1995) that showed lower levels of intervention most prevalent. It is possible that level three and level four activities have traditionally been viewed by churches/synagogues as congruent with their mission and not viewed by them as distinct health promotion/health ministry activities. It is documented that congregational health promotion can reach those of our society with limited or no access to health promotion activities (Briscoe & Pichert, 1996; Ransdell, 1995; Smith, 1992; Turner et al., 1995). It is recommended in Healthy People 2010 (U.S. Department of Health and Human Services, 2000, p. 7-6) that approaches to prevention take into account the character of the community. Though this study did not differentiate the status of access to health promotion activities for members of congregations, churches and synagogues might provide a setting that is comfortable and convenient to members of the community who might not otherwise seek out or have access to health opportunities, including minorities, the elderly, and the poor. Further research should be done to investigate whether or not health promotion efforts in churches/synagogues are reaching or have the potential to reach underserved populations. In addition, many churches and synagogues have well qualified members within their congregations who volunteer to assist with providing health promotion/health ministry activities. http://www.iejhe.org 321

The focus of the holistic view of life (body-mind-spirit) which was the primary reason indicated for church/synagogue involvement in health promotion/health ministry activities lends itself well to the multi-faceted issues that comprise health needs of diverse populations. Results of this study seem to indicate that health promotion/health ministry activities are occurring within local congregations and that the high levels of intervention coming from this sector are likely to have positive impact. While the majority of the programs are not conducted by paid staff at this point, it is likely that qualified individuals are lending their skills and talents to this work. In all likelihood, professionals with appropriate qualification who are members within congregations could be recruited to expand health promotion/health ministry activities in churches and synagogues. In the interest of creating healthier communities, it is recommended that more research be done in this area so we can better understand what can be done to support this effort. Acknowledgments The authors gratefully acknowledge Nebraska Methodist Hospital Foundation and the following individuals for their assistance with this research: Jennifer Eldridge-Houser MSHP, Ronnette Sailors BSN, Roger Hubbard BS, and Jeannie Hannan MSHP. References Briscoe,V. & Pichert, J. (1996). Promoting utilization of health care services through the African American Church. The ABNF Journal, 7, 129-132. Eickhoff-Shemek, J. & Ryan, K. (1995). A comparison of Omaha worksite health promotion activities to the 1992 national survey with a special perspective on program intervention. American Journal of Health Promotion, 10, 132-139. Lasater, T., Wells, B., Carleton, R. & Elder, J. (1986). The role of churches in disease prevention research studies. Public Health Reports, 101, 125-131. Ransdell, L. (1995). Church-based health promotion: an untapped resource for women 65 and older. American Journal of Health Promotion, 9, 333-336. Smith, E. (1992). Hypertension management with church-based education: A pilot study. Journal of National Black Nurses Association, 6, 19-28. Storlie, J., Baun, B. & Horton, W. (1992). Guidelines for Employee Health Promotion Programs. Champaign, IL: Human Kinetics Books. Turner, L., Sutherland, M., Harris, G. & Barber, M. (1995). Cardiovascular health promotion in north Florida African-American churches. Health Values, 19, 3-9. US Department of Health and Human Services. (2000). Healthy People 2010. (Conference Edition, in Two volumes). Washington, D.C.: US Government Printing Office. Copyright IEJHE 2001 http://www.iejhe.org 322