Qualitative Inquiry of African American Female Church Leaders on Facilitators and Barriers of Conducting Adult Health Programs Within African American Churches: A Pilot Study Using a Socioecological Perspective Within the United States.

Despite the success of health programs conducted within African American (AA) churches, research has been limited in understanding the facilitators and barriers of conducting adult health programs in churches led by female AA pastors/leaders. In addition, research has yet to analyze the effect of policy on these church-based health programs. Thus, this pilot study's objective is to use the socio-ecological model (SEM) as a framework to explore female AA pastors' and church leaders' perspectives, in the U.S., on facilitators and barriers that exist when conducting adult health programs within their congregations. Using snowball sampling to recruit AA female church leaders and pastors (n = 6), semi-structured interviews were conducted with study participants. Data were then transcribed and analyzed using First and Second Cycle coding to identify themes. Nine themes emerged from the data, and after stratifying the themes according to the SEM, this study found that facilitators and barriers exist at the intrapersonal, organizational, community, and policy levels of the SEM. It is important for these factors to be considered to ensure that health programs led by AA women pastors/leaders are successful within AA churches. Study limitations and the need for further research are also noted.

Facilitators and Barriers When Conducting Adult Health Programs Within the African American Church: A Systematic Review.

Despite the success of health programs conducted within African American (AA) churches, research has been limited in understanding facilitators and barriers that exist when conducting adult health programs within AA churches. Thus, the objective of this study was to systematically review the literature to identify these facilitators and barriers. A comprehensive literature search was conducted and studies that met the eligibility criteria were divided based on their focus: disease topic or behavior, health promotion activities, or church readiness. Facilitators and barriers were also stratified using the socioecological model. Out of 288 articles initially identified, only 29 were included. Facilitators and barriers were predominantly found at the intrapersonal and organizational level for disease topic or behavior studies, and at the organizational level for studies focused on health promotion activities and church readiness. None of the articles identified facilitators and barriers at the policy level.

An-m-Health Intervention Using Smartphone App to Improve Physical Activity in College Students: A Randomized Controlled Trial.

Using m-Health apps can provide researchers and others with an effective way for improving physical activity (PA) and healthy lifestyle behaviors. The promotion of health should move from a model focused on the physical and biological basis of illness and towards a focus on the behavioral changes that support health. Therefore, the aims of the current study were to improve PA (step-counts) and body weight using a theory-based m-Health app. A 12-week randomized treatment trial was carried out at Texas A&M University, Texas, college station. College students (n = 130) were recruited. They were randomized in an equal ratio of 1:1 to intervention (m-Health app) (n = 65) and control (n = 65) conditions. The response rate was (87.6%). Both groups utilized a Smartphone app. The intervention group received PA goals of (10,000 steps/day), using an m-Health app. The control group was provided with information related to daily recommended PA levels. The primary change was daily step count between the baseline and follow-up. The secondary outcome was the body mass index (BMI). Descriptive statistics were used to summarize the baseline differences between the control and intervention groups. Independent sample t-test were used for comparison between the intervention and control groups. Post-intervention PAs were higher for the intervention group (mean = 54,896.) vs. control group (mean = 45,530.12; p < 0.05). The intervention group's step-counts increased significantly (pre-mean = 40,320.38 steps per week; post-mean = 54,896.27 steps per week, p < 0.05). The body-weight changes were significant among the intervention group (p < 0.05). m-Health apps can increase PA and improve body weight, with goal setting and feedback as key intervention components. Future studies should personalize PA goals and feedback.

Impact of a Gardening and Physical Activity Intervention in Title 1 Schools: The TGEG Study.

Background: The purpose of the Texas!Grow!Eat!Go! (TGEG) study was to assess individual and combined effects of school-based gardening and physical activity (PA) interventions on children's eating and PA behaviors and obesity status. Methods: Using a 2 × 2 design, 28 low-income schools in Texas were randomized to 1 of 4 conditions: (1) School Garden intervention (Learn!Grow!Eat!Go! [LGEG]), (2) PA intervention (Walk Across Texas [WAT!]), (3) both Garden and PA intervention (Combined), or (4) neither Garden nor PA intervention (Control). Participants included 1326 third grade students and parents (42% Hispanic; 78% free/reduced lunch). Student and parent data were collected at the beginning and end of the school year. Two different sets of analyses measuring pre-post changes in outcomes within and across conditions were estimated by factorial ANOVAs using mixed models adjusted for demographics. Results: Main effect analyses indicate that relative to children at schools that did not receive LGEG, children at schools that received LGEG, either individually or in combination with WAT!, showed significant increases in Nutrition knowledge, Vegetable preference, and Vegetable tasted (p < 0.001 in all cases). Within-group analyses show that compared to Comparison, children in the WAT! group significantly increased in the amount of time parents and children were active together (p = 0.038). In addition, children in LGEG and WAT! schools significantly decreased BMI percentile (p = 0.042, p = 0.039, respectively), relative to children in Comparison schools. Conclusions: Both the garden and PA interventions independently produced significant changes related to healthy lifestyle behaviors. However, combining the two interventions did not show greater impact than the single interventions, underscoring the need for more research to determine how to better implement comprehensive interventions at schools.

Shared-Use Decisions Among Administrators of Physical Activity Facilities in Pasadena, TX.

Background and Purpose. The American Heart Association recommends community-based research on shared use of physical activity (PA) spaces. Pasadena, a community in southeast Houston, Texas with lower socioeconomic status and racial/ethnic diversity, was the setting for our study. Efforts to increase access to PA in Pasadena include building the evidence on PA resources. The purpose of this research was to utilize survey data in a community setting to inform and target efforts around sharing PA spaces. Method. An online survey was administered to K-12 school (n = 25) and park (n = 30) administrators, church leaders (n = 10), community organizations (n = 2), a health care center, and a local business. Results. Park facilities in Pasadena shared by agreement with two high schools and three baseball/softball leagues were ballfields, tennis courts, and jogging paths. No park facilities were shared with faith-based organizations. Four parks communicated daily, and five schools communicated with parks quarterly about providing opportunities for PA. Key facilitators to sharing facilities were building relationships and collaboration, service to the community, and improving health. Key barriers were cost, maintenance, staffing, and prioritizing use with limited time, facilities, and resources. Conclusions. This study is the first of its kind to address shared use at the community level and suggests opportunities to improve communication and partnerships between parks, schools, and churches. This research will inform ongoing efforts to promote access by identifying barriers and motivators among stakeholder groups to help facilitate shared use agreements.

Using community-based methods to create a geospatial asset map of physical activity spaces in Pasadena, TX.

Sharing of physical activity spaces is supported by the American Heart Association and other leading public health authorities as one strategy to increase access to physical activity. The purpose of this study was to identify facilities within Pasadena, TX, that currently provide opportunities for active recreation, sport, and other forms of physical activity and analyze community access to these spaces from a geospatial perspective. Geospatial analysis was used to identify physical activity spaces and issues relevant to access. Using a community-based approach, the research team worked with partners to create a list of individuals responsible for each of the physical activity spaces. These "facility administrators" were contacted by email and then phone for a total of four attempts. Respondents were asked to complete an online shared use survey. An asset map was created from both local geospatial data (Pasadena, TX) and data from a facility access and shared use survey. Of the 39 facility administrators, 23 responded to the survey and consisted of the park director, school principals, lead pastors and clergy, and business owners. A total of 53 facilities were identified within the priority zip codes, including 30 parks, 25 schools, 9 faith-based organizations, and 4 others (a business, a nonprofit health care center, and two community-based organizations). Overall, there were 131 total amenities, and playgrounds, outdoor basketball courts, and ball fields were the most common types. Some facilities had multiple amenities at their location, including many of the parks and schools. Additionally, respondents noted other types of amenities where activity took place such as parking lots, grassy areas, classrooms, and other indoor areas. Many of the amenities, 102, were open to the general public and 28 were found to be in good condition. Findings suggest that there is inadequate access to physical activity spaces in this underserved community. There is a need for additional play spaces in Northern Pasadena and for future research bridging community health and geospatial mapping.

Assessing Health Literacy Among Chinese Speakers in the U.S. with Limited English Proficiency.

BACKGROUND: Limited English proficiency compounds the problem of low health literacy, making certain population groups in the United States especially vulnerable to health disparities. OBJECTIVE: This study clarified the mechanisms underlying low health literacy among people with limited English proficiency using a modified theory-based health literacy assessment survey. METHODS: We modified and tested the All Aspects of Health Literacy Scale (AAHLS) with a sample of Chinese speakers who have limited English proficiency in the U.S. The AAHLS is a theory-based health literacy survey assessing functional health literacy, interactive health literacy, information appraisal, and empowerment. We adapted the survey, created dual language scenarios (English and Chinese), translated the questions into Chinese, and conducted cognitive interviews to revise the questions. We examined the health literacy score distributions and performed Confirmatory Factor Analysis (CFA) to evaluate the appropriateness of our modified AAHLS to elicit valid data. KEY RESULTS: A total of 405 participants completed our AAHLS survey. Compared to the English language scenario, aside from the item assessing if participants would question health care providers, participants had significantly higher health literacy levels when they were immersed in communication using Chinese (p < .001). We also found that more than three-quarters of the participants were not likely to question their doctor's and nurse's advice regardless of language scenarios and most of them had limited empowerment capabilities at the level of community and social engagement. The CFA results showed that the modified Chinese model exhibited good fit (RMSEA [root mean square error of approximation] = 0.06, CFI [the comparative fit index] = 0.98, TLI [Tucker-Lewis index] = 0.97, WRMR [weighted root mean square residual] = 1). CONCLUSIONS: The results showed that our modified AAHLS yielded reliable and valid data among U.S. Chinese speakers. Researchers should consider native languages and cultural differences before conducting health literacy assessments. Public health professionals should incorporate health interventions and policy approaches to improve Chinese immigrants' English proficiency and empowerment capabilities. [HLRP: Health Literacy Research and Practice. 2018;2(2):e94-e106.]. PLAIN LANGUAGE SUMMARY: To clarify the mechanisms underlying low health literacy among populations with limited English proficiency (LEP) in the United States, this study aims to tailor a theory-based health literacy survey with dual-language scenarios among Chinese speakers with LEP. The modified survey yielded reliable and valid data. Participants had higher health literacy levels when they were immersed in communication using Chinese rather than English.

Integrating the Principles of Socioecology and Critical Pedagogy for Health Promotion Health Literacy Interventions.

While health literacy research has experienced tremendous growth in the last two decades, the field still struggles to devise interventions that lead to lasting change. Most health literacy interventions are at the individual level and focus on resolving clinician-patient communication difficulties. As a result, the interventions use a deficit model that treats health literacy as a patient problem that needs to be fixed or circumvented. We propose that public health health literacy interventions integrate the principles of socioecology and critical pedagogy to develop interventions that build capacity and empower individuals and communities. Socioecology operates on the premise that health outcome is hinged on the interplay between individuals and their environment. Critical pedagogy assumes education is inherently political, and the ultimate goal of education is social change. Integrating these two approaches will provide a useful frame in which to develop interventions that move beyond the individual level.

Risk Factors for Childhood Obesity among Asian Americans: A Systematic Review of Literature and Recommendations for Health Care Research.

Childhood obesity has become an epidemic across all racial/ethnic groups in the U.S., including Asian Americans. With different cultures, beliefs, and lifestyles, Asian Americans may face unique sets of risk factors for childhood obesity. This review critically assesses and summarizes the literature on risk factors for childhood obesity among Asian Americans. Among the 14 studies identified, five (35.7%) used national or state-level data, seven (50%) targeted Chinese Americans, and two (14.3%) focused on Hmong Americans. Multiple risk factors for childhood obesity among Asian Americans were reported, including acculturation, generational status, and family functioning. Limitations of the literature included use of small samples, scarcity of ethnically specific data for Asian American subgroups, shortage of qualitative studies, and lack of theoretical foundation. More disaggregated studies are needed to examine the important variability that may exist in risk factors for childhood obesity among Asian American subgroups.