Date of Award
Open Access Dissertation
Rural residents experience a greater burden of chronic disease related to physical inactivity and poor diet than their urban counterparts. A promising strategy to improve these health behaviors in rural areas is to leverage existing structures that may support physical activity and healthy eating, such as churches, in public health interventions. Three studies were conducted as part of this dissertation. They were designed to: 1) examine whether the walkability and healthy food density of neighborhoods surrounding rural and urban churches are associated with race, socioeconomic status, and rural/urban status; 2) examine rural church leaders’ views on the role of faith-based organizations in improving physical activity and healthy eating in rural communities and the viability of using rural churches as spaces for community physical activity and healthy eating initiatives; 3) analyze the effect of home neighborhood walkability and healthy food density on changes in church member physical activity and healthy eating in the context of a 12-month faith-based intervention.
In my study of church neighborhood walkability and healthy food density in 990 United Methodist Churches (UMC) in South Carolina (SC), we found that churches located in urban neighborhoods had better neighborhood walkability scores than those located in rural areas (r=0.29, p<.0001). Further, churches with predominantly white congregations had more favorable neighborhood walkability scores than those with predominantly Black/African American congregations (r=0.08, p=.02). At higher income levels, churches with predominantly white congregations had better neighborhood walkability scores than those with predominantly Black/African American congregations (p=.03). There may be value in encouraging churches, especially Black churches, to audit their neighborhood walkability and healthy food density to promote advocacy for enhanced physical activity and food environments and/or policies.
In my second study, interviews with 17 pastors of rural UMC churches in SC showed that most churches had a kitchen (88%), classrooms (82%), and open field space (71%), all of which could be leveraged for physical activity and/or healthy eating promotion. Most pastors (53%) also reported having formal or informal shared use agreements in place, but few pertaining to physical activity (12%) and none to healthy eating. The themes that emerged from interviews described community environment and church-level barriers and enablers to health promotion, as well as pastors’ perceived barriers and enablers to shared use agreements. In general, rural pastors view health promotion as an important aspect of church outreach, however rural communities are limited in their physical activity and healthy eating infrastructure. Further, rural pastors are open to sharing church space and few barriers exist to putting these types of agreements into place. Policymakers in rural areas should consider approaching rural churches to implement shared use agreements and expand access to physical activity and healthy eating facilities for the community.
In my third study, I hypothesized that church members with more favorable home neighborhood walkability and healthy food density environments would report greater changes in physical activity and fruit and vegetable intake while taking part in a 12-month faith-based physical activity and healthy eating organizational intervention. A total of 232 participants from seven churches completed baseline surveys and 166 completed 12-month surveys (72% retention). On average, participants lived in neighborhoods with walkability scores that were below national average. Mean mRFEI score for participant home addresses was 10.8, which is slightly greater than the national average. Contrary to hypotheses, I did not find a time*neighborhood environment interaction. A time effect revealed that physical activity, fruit consumption, and vegetable consumption increased over time. Further, education status and age were positively associated with moderate to vigorous PA and vegetable consumption, respectively.
Faith-based organizations are promising partners for physical activity and healthy eating interventions, as churches are located in virtually every community across the country, including traditionally underserved rural settings. In rural communities, churches are well-equipped for physical activity and healthy eating initiatives as internal physical activity and healthy eating supports (like fellowship halls or kitchens) or external physical activity and healthy eating supports are often present. This dissertation identifies disparities in church neighborhood environments that should be addressed in the context of physical activity and healthy eating interventions in faith-based settings. It also highlights the potential of partnering with rural churches to develop and deliver health promoting-activities, and the need to examine and understand the multiple diverse environments that determine individual health behaviors. These results may be used as a foundation for future research in environmental faith-based interventions, particularly those that seek to partner with churches to enhance community access to space for physical activity and healthy eating in rural areas.
Day, K. R.(2023). Leveraging Church Environments to Promote Rural Physical Activity and Healthy Eating. (Doctoral dissertation). Retrieved from https://scholarcommons.sc.edu/etd/7373
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