Date of Award
Doctor of Philosophy (PhD)
Health Outcomes and Policy Research
Shelley I. White-Means, Ph.D.
Wendy Likes, Ph.D., D.N.Sc., A.P.R.N-BC Nancy Mele, R.N., Ph.D. Latrice C. Pichon, Ph.D., M.P.H. George E. Relyea, M.S.
Objective: The objective of this analysis was to evaluate the relationship between organizational readiness (OR) and weight loss and physical activity outcomes among faith-based organizations (FBOs).
Methods: Data for this study were collected in two phases. Phase I data were based on a feasibility study and targeted African-American individuals (N = 55) who participated in an obesity prevention program. The intervention was accomplished in two stages, which included a 10-week core period followed by a 6-month maintenance period. Phase II data were based on key informant interviews that were conducted with community health leaders (CHLs) (N=6) from participating FBOs. These interviews addressed six dimensions of readiness, with each dimension receiving an independent score that ranged from 1 to 9 (no awareness to a high level of community ownership). Dimension scores were averaged and each FBO was assigned a numerical OR score. OR scores were computed from the interview data, utilizing anchored rating scales outlined in the Community Readiness Model (CRM). These scores were subsequently combined with the Phase I data and used to statistically estimate the associations of OR. Linear mixed models, using SAS/STAT® software, were used to evaluate the relationship between OR scores and weight loss and physical activity while adjusting for covariates. A qualitative analysis of the Phase II data was also performed.
Results: Approximately 12.5% of the sample had an OR score of 4, 69.6% had an OR score of 5, while 17.9% were assigned an OR score of 7. An OR score of four indicated a pre-planning stage of readiness. Those with an OR score of 5 were in the preparation stage of readiness, while those with a score of seven were in the stabilization stage.
An OR score of 5 was associated with a significant increase in weight (2.532, p=0.048) when compared with an OR score of 7. Post hoc analysis revealed significant mean differences in weight when comparing congregation 1 with congregations 4 (difference=3.452, p=0.016) and 5(difference= 4.646, p=0.0005). Congregation 2 had a significant mean difference in weight compared to both congregations 4 (difference= 5.264, p<0.0006) and 5 (difference= 6.457, p<0.0001).
During the maintenance period, Group(s) with an OR score of 5 gained weight compared to those with an OR score of 7 (6.093, p=0.0018). Post hoc analyses revealed significant mean differences between congregation 1 and congregations 4 (difference=7.896, p=0.001) and 5 (difference= 10.708, p=0.003).
The mean activity level of group(s) with an OR score of 4 and 5 were 166.02 minutes (p<0.0001) and 177.33 minutes (p<0.001) lower, respectively, than the group with an OR score of 7. Post hoc analysis revealed significant mean differences in physical activity minutes for congregation 1 compared with congregations 2 (difference= -91.698, p=0.011), and 4 (difference= -203.90, p<0.0001). There were also significant mean differences between congregations 2 versus 4 (-112.20, p= 0.010) and 4 versus 5 (155.18, p<.0006). There were also statistically significant differences in physical activity by OR category. Physical activity minutes among group(s) with an OR score of 4 (-1284.21, p<0.0001) and 5 (-933.21, p<0.0001) were lower than those with a score of 7. The post hoc analysis revealed significant mean differences between congregations 2 (-2191.82, p<0.0001), and 4 (-1631.77, p<0.0001) when compared with congregation 1. There were also significant mean differences in physical activity between congregations 2 versus 3 (difference= 2557.60, p=0.0009) and 5(difference=1602.11, p<0.001), 3 versus 4 (difference= -1997.55, p=0.007) and 4 versus 5 (difference= 1042.06, p<0.001).
Despite the enthusiasm of participating FBO, the qualitative evaluation revealed that health behavior change can be difficult to adopt and maintain. Moving into an organization that is well structured is seemingly a great formula for success; however, the strength of the organization alone is not sufficient to promote and support health behavior change. Irrespective of an organization’s position on the readiness continuum, several barriers may exist. Primary obstacles included: age of the congregation, competing activities, time frame of the initiative, recognizing the issue and appropriate problem solving, motivation and cost of healthy food options.
Conclusion: Although physical activity and weight outcomes were associated with OR scores, the post-hoc analysis revealed variations in outcomes by congregation. Congregational differences may be attributable to intra-group distinctions rather than organizational readiness levels. Therefore, health promotion coordinators must work closely with FBO to pinpoint effective recruitment, implementation, and maintenance strategies that reach the community at various sectors.