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Background: There is a high burden of chronic diseases such as hypertension and diabetes in small island developing states (SIDS). SIDS governments have committed to a range of public health, healthcare, and fiscal measures to reduce this burden including community-based health education in collaboration with civil society organizations. We sought to explore perceived acceptability, appropriateness, and feasibility of implementing self-management health programs in 20 faith-based organizations in the small island developing state of Barbados. Methods: This was a concurrent mixed methods study - a quantitative online survey and a qualitative inquiry using semi-structured interviews. Acceptability, appropriateness and feasibility of the intervention were assessed using the following quantitative assessment tools: Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM) and Feasibility of Intervention Measure (FIM). Thirteen in-depth interviews were conducted virtually, recorded and transcribed verbatim. Transcripts were analyzed using thematic analysis based on deductive codes from Proctor's implementation outcomes definitions. Results: From the 52 respondents of the survey, the median and interquartile ranges for the AIM, IAM and FIM scales were 16 (15-20), 16 (16-20) and 16 (15-17) (out of 20), respectively. We found high levels of acceptability, 82% (95% CI (69%, 95%)) of leaders indicating that health programs in churches met with their approval; and high levels of appropriateness-90% (95% CI (80%, 100%)) indicating health programs in churches were "fitting" and "a good match". Feasibility scores were lower, with 60% (95% CI (44%, 76%)) indicating that health programs in churches would be easy to use. In interviews, leaders expressed acceptance of healthy lifestyle programs in churches and described their appropriateness through alignment with church doctrines stating, "the body is the temple of God". They felt that economic impacts from COVID-19 were likely to be a barrier to the success of programs. Leaders expressed the need for support from healthcare providers who are sensitive and respectful of church culture. Conclusion: We found that health-based programs in churches align well with church doctrines, but the success of these programs will depend on establishing trust through the engagement of church-based champions, tailoring programming to include a biblical perspective and engaging entire households.
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Objective: To investigate the effects of developing religiosity on abstinence of substance abuse among recovering addicts in a faith-based and a secular-based treatment program. Methods: Religiosity of recovering addicts was measured using the 38-item Brief Multidimensional Measure of Religiousness/Spirituality at three points in time: at initiation of substance addiction treatment (wave 1), discharge from treatment (wave 2), and 6 months after treatment (wave 3). Latent growth curve modeling was used to assess the dynamic and developing effects of religiosity on after-treatment abstinence. Secular-based treatment emphasized the role of biological, psychological, and environmental determinants of substance abuse and provided detoxification interventions, such as counseling and group therapies, skill training, health care, and social support, however also relying on religious and spiritual growth to help recovery. Faith-based treatment fundamentally emphasized the Christian theory of addiction to consider substance abuse a sin caused by one's spiritual void and separation from God, although it also acknowledged the importance of biological, psychological, and social needs of rehabilitants. Results: Recovering addicts in faith-based treatment had significantly higher levels of religiosity at each wave (intercept factor) and better religious development across the three waves (slope factor). This contributed to after-treatment abstinence and mediated the effect of treatment mode on after-treatment abstinence. Conclusion: Service practitioners and researchers should note the importance of dynamic and developing nature of religiosity in relation to the maintenance of abstinence after treatment is completed.
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OBJECTIVES: The aims of this feasibility study were to (1) examine the implementation of a community-based health advocate (CHA) training programme to develop the clinical skills needed to support a diabetes remission protocol based on a low-calorie diet (LCD) and (2) investigate if participant weight loss can be achieved and diabetes remission induced under these conditions. METHODS: This tripartite study followed a type 2 implementation-effectiveness design. Three faith-based organisations (FBOs) were purposively selected as study sites. Implementation outcomes were guided by the Consolidated Framework for Implementation Research. During the pre-implementation phase, site 'readiness' to facilitate the intervention was determined from a site visit and an interview with the FBOs' leadership. During the implementation phase, congregants could volunteer for the 10-week CHA training which included practical exercises in weight, glucose and blood pressure (BP) measurement, and a summative practical assessment. Acceptability and implementation effectiveness were assessed via survey. During the intervention phase, other congregants and community members with T2DM or pre-diabetes and overweight were invited to participate in the 12-week LCD. Anti-diabetic medication was discontinued on day 1 of the intervention. Clinical effectiveness was determined from the change in weight, fasting blood glucose (FBG) and BP which were monitored weekly at the FBO by the CHA. HbA1C was performed at weeks 1 and 12. RESULTS: The FBOs were found to be ready as determined by their adequate resources and engagement in health-related matters. Twenty-nine CHAs completed the training; all attained a passing grade at ≥1 clinical station, indicating implementation effectiveness. CHA feedback indicated that the programme structure was acceptable and provided sufficient access to intervention-related material. Thirty-one persons participated in the LCD (11 T2DM:20 pre-diabetes). Mean (95%CI) weight loss was 6.0 kg (3.7 to 8.2), 7.9 kg in males vs 5.7 kg in females; A1C (%) decreased from 6.6 to 6.1, with a greater reduction in those with T2DM when compared to pre-diabetes. FBG decreased from 6.4 to 6.0mmol/L. T2DM remission rates were 60% and 90% by A1C<6.5% and FBG<7mmol/L respectively. Pre-diabetes remission was 18% and 40% by A1C<5.7% and FBG<5.6 respectively. CONCLUSION: Implementation of a community-based diabetes remission protocol is both feasible and clinically effective. Its sustainability is to be determined. Adaptability to other disorders or other settings should be investigated. TRIAL REGISTRATION: NCT03536377 registered on 24 May 2018.
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Traditional youth baseball academies in the Dominican Republic, along with the potential of a major league baseball contract, are viewed by many parents as the best option to pull a child and family out of poverty. These academies advance the child's athletic abilities yet fail to provide formal education. Unfortunately, 97% of athletes leave the academy without a contract and are left with little education, job skills, or stable job prospects which ultimately returns them to the life of poverty they had hoped to escape through baseball. A faith-based organisation in Santiago, Dominican Republic, offers a high-level baseball academy inclusive of supportive academics. The purpose of this research project was to describe the perspectives of stakeholders involved with the faith-based missional organisation to discern the components and effectiveness of the efforts to support student growth in and beyond athletic abilities. Utilising a community-based research approach with a social determinants of health theoretical framework, researchers held in-country focus group discussions (Spring, 2019) with the organisation's stakeholders (coaches, parents, community leaders, N = 33). Researchers collaboratively coded data, triangulating within and across sources, to identify themes. Qualitative data suggest stakeholders within this organisation perceive the academy as instrumental in keeping kids off the streets, encouraging self-discipline in sports, church and school. The stakeholders perceived the inclusion of academic expectations into the sports academies improved long-term educational and economic success for the athletes. Inclusion of academic requirements within sports academies may improve long-term outcomes of youth in the Dominican Republic.
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Béisbol , Educación , Determinantes Sociales de la Salud , Adolescente , Niño , Investigación Participativa Basada en la Comunidad , República Dominicana , Organizaciones Religiosas , Femenino , Grupos Focales , Humanos , Masculino , Participación de los InteresadosRESUMEN
BACKGROUND: Latin America ranks among the regions with the highest level of intake of sugary beverages in the world. Innovative strategies to reduce the consumption of sugary drinks are necessary. PURPOSE: Evaluate the effect of a one-off priest-led intervention on the choice and preference of soda beverages. METHODS: We conducted a pragmatic cluster-randomized trial in Catholic parishes, paired by number of attendees, in Chimbote, Peru between March and June of 2017. The priest-led intervention, a short message about the importance of protecting one's health, was delivered during the mass. The primary outcome was the proportion of individuals that choose a bottle of soda instead of a bottle of water immediately after the service. Cluster-level estimates were used to compare primary and secondary outcomes between intervention and control groups utilizing nonparametric tests. RESULTS: Six parishes were allocated to control and six to the intervention group. The proportion of soda selection at baseline was ~60% in the intervention and control groups, and ranged from 56.3% to 63.8% in Week 1, and from 62.7% to 68.2% in Week 3. The proportion of mass attendees choosing water over soda was better in the priest-led intervention group: 8.2% higher at Week 1 (95% confidence interval 1.7%-14.6%, p = .03), and 6.2% higher at 3 weeks after baseline (p = .15). CONCLUSIONS: This study supports the proof-of-concept that a brief priest-led intervention can decrease sugary drink choice. CLINICAL TRIAL INFORMATION: ISRCTN, ISRCTN24676734. Registered 25 April 2017, https://www.isrctn.com/ISRCTN24676734.
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Bebidas Gaseosas , Conducta de Elección , Clero , Azúcares de la Dieta , Conducta de Ingestión de Líquido , Promoción de la Salud , Catolicismo , Agua Potable , Femenino , Promoción de la Salud/métodos , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Perú , Prueba de Estudio ConceptualRESUMEN
Abstract: Introduction: Faith-based centers are major providers of residential treatment for substance use problems in Mexico, but relatively few studies have been conducted in this context. Objective: To explore factors associated with treatment retention in two faith-based (with different religious orientation) residential treatment facilities for male drug users in Tijuana, Mexico. Method: We conducted an exploratory follow-up study of 328 clients admitted during 2014-2015 to either an Evangelical Pentecostal center or a faith-based center without a specific religious affiliation. The main outcome was retention, defined as remaining in treatment for at least three months. Results: Among participants, the retention rate was 38.7%. Multivariate logistic regression models showed that age (OR 1.04; 95% CI [1.01, 1.06]; p = .002) and having used heroin or opioids in the past 30 days (OR .50; 95% CI [.25, 1.00]; p = .049) were associated with retention. Having a personal religious affiliation was associated with retention in the Evangelical Pentecostal center, but not in the center without a specific religious affiliation. Discussion and conclusion: The retention rate was low, but within the previously reported range. The interaction of personal religious affiliation and the religious orientation of the center suggests that a match between a person's religious convictions and those of the center could be important for retention. More research is needed to clarify the utility of faith-based centers for religious and non-religious drug users.
Resumen: Introducción: Aunque los centros de rehabilitación religiosos proporcionan tratamiento a un gran número de usuarios de drogas en México, existen relativamente pocos estudios sobre estos centros. Objetivo: Explorar los factores asociados con la retención en el tratamiento en dos centros de rehabilitación para hombres usuarios de drogas con diferentes orientaciones religiosas en Tijuana, México. Método: Estudio longitudinal exploratorio de 328 usuarios admitidos durante 2014-2015 en un centro evangélico pentecostal y en un centro religioso sin denominación específica. El resultado principal fue la retención, definida como la permanencia en tratamiento por al menos tres meses. Resultados: La tasa de retención entre los participantes fue de 38.7%. En el análisis con modelos de regresión logística multivariada la edad (OR 1.04; 95% CI [1.01, 1.06]; p = .002) y haber utilizado heroína u opioides en los últimos 30 días (OR .50; 95% CI [.25, 1.00]; p = .049) se asociaron con la retención. Tener una adscripción religiosa personal se asoció con retención en el centro evangélico pentecostal, pero no en el centro sin afiliación religiosa específica. Discusión y conclusión: La tasa de retención observada fue baja, aunque dentro del rango previamente reportado. La interacción entre adscripción religiosa personal y orientación religiosa del centro sugiere que la concordancia entre estos dos elementos podría facilitar la retención. Se requiere más investigación en este contexto para clarificar la utilidad de los centros de rehabilitación religiosos en el tratamiento de usuarios religiosos y no religiosos.
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RESUMEN Este trabajo se propone comprender los sentidos del trabajo religioso en la prevención de la violencia y la recuperación de personas involucradas con actos ilícitos en un complejo de favelas de la ciudad de Río de Janeiro, Brasil. Se analizan la acción de entidades religiosas en el territorio, las visiones de sus líderes sobre su papel y el de su iglesia y sus representaciones sobre el territorio y sobre las personas que realizan actos violentos. Entre 2010 y 2012, desde un abordaje cualitativo, se realizó observación participante y se efectuaron entrevistas a líderes religiosos y "convertidos", cuyos relatos se abordaron a través de análisis de la enunciación. Los líderes resaltan la importancia de la acción de sus iglesias en una localidad precaria y violenta y los "convertidos" destacan el papel de la evangelización en su conversión religiosa. Sin embargo, las relaciones entre religión y violencia son complejas e incluyen varios tipos de trayectorias y comportamientos: si bien se destaca la fuerza del apoyo religioso, también se la cuestiona. Se concluye que las iglesias actúan de forma puntual e individual, por lo que colaboran poco con la transformación de la realidad, asumiendo con frecuencia un papel de control y de pacificación de la cuestión social.
ABSTRACT The purpose of this study is to understand the meanings of religious work in the prevention of violence and in the recovery of people involved in illicit acts in a complex of shantytowns in Rio de Janeiro, Brazil. The activities of religious entities in the territory, the view of religious leaders regarding their role and that of their church, and the representations of the territory and of the people who commit violent acts were analyzed. Using a qualitative approach, participant observation and interviews of religious leaders and "converts" were conducted between 2010 and 2012. The resulting narratives were treated using enunciation analysis. The leaders emphasize the importance of their churches' actions in violent and precarious areas, while the "converts" highlight the role of evangelization in their religious conversion. However, the relationships between religion and violence are complex, involving various types of trajectories and behaviors; in this way, the strength of religious support in the conversion process is both highlighted and questioned. The text concludes that churches' actions tend to be palliative and focused on the individual and therefore do little to transform reality, with the church potentially taking on roles of social control and pacification.
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Humanos , Pobreza , Religión , Violencia/prevención & control , Controles Informales de la Sociedad , Población Urbana , Trabajo , Brasil , Organizaciones Religiosas , LiderazgoRESUMEN
OBJECTIVE: To review and assess the effectiveness of physical activity interventions delivered in faith-based organizations. DATA SOURCE: We searched the Cochrane Library, DoPHER, EMBASE, LILACS, MEDLINE, PsycINFO, WHO ICTRP, and Clinicaltrials.gov databases until January 2016, without restriction of language or publication date. STUDY INCLUSION AND EXCLUSION CRITERIA: Randomized and nonrandomized controlled trials investigating physical activity interventions for adults delivered in faith-based organizations. DATA EXTRACTION: Two independent reviewers extracted data and assessed study methodological quality. DATA SYNTHESIS: We used relative risk and mean difference with 95% confidence interval to estimate the effect of the interventions on measures of physical activity, physical fitness, and health. RESULTS: The review included 18 studies. Study participants were predominantly female, and the majority of trials were conducted in the United States. Study heterogeneity did not allow us to conduct meta-analyses. Although interventions delivered in faith-based organizations increased physical activity and positively influenced measures of health and fitness in participants, the quality of the evidence was very low. CONCLUSION: Faith-based organizations are promising settings to promote physical activity, consequently addressing health disparities. However, high-quality randomized clinical trials are needed to adequately assess the effectiveness of interventions delivered in faith-based organizations.
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Ejercicio Físico , Organizaciones Religiosas/organización & administración , Promoción de la Salud/organización & administración , Glucemia , Presión Sanguínea , Pesos y Medidas Corporales , Ensayos Clínicos como Asunto , Estado de Salud , Humanos , Lípidos/sangre , Aptitud FísicaRESUMEN
BACKGROUND: Faith-based organizations (FBOs) have a long history of providing health services in developing countries and are important contributors to healthcare systems. Support for the wellbeing of women, children, and families is evidenced through active participation in the field of family planning (FP). However, there is little quantitative evidence on the availability or quality of FP services by FBOs. METHODS: The descriptive analysis uses facility-level data collected through recent Service Provision Assessments in Malawi (2013-14), Kenya (2010), and Haiti (2012) to examine 11 indicators of FP service and method availability and nine indicators of comprehensive and quality counseling. The indicators include measures of FP service provision, method mix, method stock, the provision of accurate information, and the discussion of reproductive intentions, client's questions/concerns, prevention of sexually transmitted infections, and return visits, among others. Pearson's Chi-square test is used to assess the selected indicators by managing authority (FBO, public, and other private sector) to determine statistical equivalence. RESULTS: Results show that FBOs are less likely to offer FP services than other managing authorities (p < 0.05). For example, 69% of FBOs in Kenya offer FP services compared to 97% of public facilities and 83% of other private facilities. Offering long-acting or permanent methods in faith-based facilities is especially low (43% in Malawi, 29% in Kenya and 39% in Haiti). There were few statistically significant differences between the managing authorities in comprehensive and quality counseling indicators. Interestingly, Haitian FBOs often perform as well or better than public sector health facilities on counseling indicators, such as discussion of a return visit (79% of FBO providers vs. 68% of public sector providers) and discussion of client concerns/questions (52% vs. 49%, respectively). CONCLUSIONS: Results from this analysis indicate that there is room for improvement in the availability of FP services by FBOs in these countries. Quality of counseling should be improved by all managing authorities in the three countries, as indicated by low overall coverage for practices such as ensuring confidentiality (22% in Malawi, 47% in Kenya and 12% in Haiti), discussion of sexually transmitted infections (18%, 25%, 17%, respectively), and providing services to youth (53%, 27%, 32%, respectively).
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Consejo/normas , Organizaciones Religiosas/normas , Servicios de Planificación Familiar/provisión & distribución , Accesibilidad a los Servicios de Salud , Calidad de la Atención de Salud , Religión y Sexo , Acceso a la Información/psicología , Anticoncepción/psicología , Anticoncepción/estadística & datos numéricos , Consejo/organización & administración , Consejo/estadística & datos numéricos , Atención a la Salud/organización & administración , Atención a la Salud/normas , Atención a la Salud/estadística & datos numéricos , Organizaciones Religiosas/estadística & datos numéricos , Servicios de Planificación Familiar/normas , Servicios de Planificación Familiar/estadística & datos numéricos , Femenino , Haití/epidemiología , Accesibilidad a los Servicios de Salud/organización & administración , Accesibilidad a los Servicios de Salud/normas , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Encuestas Epidemiológicas , Humanos , Kenia/epidemiología , Malaui/epidemiología , Masculino , Educación Sexual/organización & administración , Educación Sexual/normasRESUMEN
Al revisar el Plan de Salud Territorial de Barranquilla no se encuentra evidencia de la participación de organizaciones basadas en la fe (OBF) en el diseño del mismo, aun cuando estas son parte representativa de la población y se perciben a sí mismas como conocedoras de la situación de salud pública y promotoras de acciones encaminadas al mejoramiento de la salud de las comunidades a que sirven. Por ello la cohorte de estudiantes de la sexta promoción de la Maestría en Salud Pública de la Universidad del Norte decidió dar a conocer esta reflexión con objeto de motivar a las diferentes instancias gubernamentales a evaluar la iniciativa de inclusión de representantes comunitarios en las mesas de participación. Esperamos también que esta reflexión motive a las organizaciones no gubernamentales basadas en la fe a que examinen y reconozcan la importancia de su participación en las mesas de trabajo convocadas por el sector público con el fin de lograr una integración que permita una mejor coordinación de acciones de promoción, planeación, implementación y sostenimiento de proyectos orientados al mejoramiento de la Salud Pública en el distrito de Barranquilla.
A review of the Barranquilla Territorial Health Plan shows no evidence of involvement of faith based organizations (FBOs) in its design and implementation, even though they are community based organizations that see themselves as knowledgeable of the public health situation in their communities, and as promoters of actions aimed at improving the health of the community they serve. Therefore, the Universidad Del Norte Public Health Master students (sixth cohort) and their professor decided to deliver the following reflection in order to motivate the various government agencies to examine their Territorial Health Plan implementation, particularly the community-based organizations participation component. In addition, we hope to motivate faith-based organizations to examine and recognize the importance of their participation in the working groups convened by the public sector, in order to achieve an integration aiming to better coordinate activities associated with the promotion, planning, implementation and sustainability of Public Health projects in the District of Barranquilla.
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OBJECTIVE: This exploratory study conducted in 2008 aimed at gathering the views and opinions of leaders of the faith-based community (FBC) in Grenada about the increased incidence of HIV/AIDS in the Caribbean region including their beliefs and attitudes towards persons living with HIV/AIDS (PLHIV/AIDS). DESIGN AND METHODS: The study followed a cross-sectional design and used a qualitative approach. Telephone surveys were conducted with all faith-based organizations and semi-structured interviews done with key leaders representing the faith-based community in Grenada. RESULTS: Findings showed that perceptions of HIV/AIDS are embedded in a socio-political-cultural context where many risk behaviours and factors intertwine in complex ways. Religious beliefs are based on love, compassion and acceptance. The most prominent risk behaviours associated with the spread of HIV/AIDS identified by leaders are homosexuality, prostitution, promiscuity and substance abuse which are in direct contradiction to their beliefs and teachings. Leaders felt that these risk behaviours were exacerbated by changes in family structure and the absence of a common moral discourse shared by all sectors of society. CONCLUSION: The faith-based community has a significant presence across Grenada and it can be an effective partner in helping communities understand and prevent HIV/AIDS and overcome the stigma and discrimination associated with this disease. Training and effective strategies are needed to engage them in the national response to HIV/AIDS without threatening their ideologies and practices.
OBJETIVO: Este estudio exploratorio realizado en 2008 tuvo por objetivo recoger los puntos de vistas y opiniones de líderes de la comunidad de fe en Granada, acerca del aumento de la incidencia de VIH/SIDA en la región caribena, incluyendo sus creencias y actitudes hacia personas que viven con VIH/SIDA (PLVIH/SIDA). DISEÑO Y MÉTODOS: El estudio tuvo por base un diseno transversal y un enfoque cualitativo. Se llevaron a cabo encuestas telefónicas con todas las organizaciones de fe y se realizaron entrevistas semiestructuradas a líderes importantes, representantes de la comunidad defe en Granada. RESULTADOS: Los hallazgos mostraron que las percepciones del VIH/SIDA se hallan embebidas en un contexto socio-político-cultural en el que múltiples comportamientos y factores de riesgo se entrelazan deformas complejas. Las creencias religiosas se basan en el amor, la compasión y la aceptación. Los comportamientos de riesgo más sobresalientes asociados con la diseminación del VIH/SIDA, identificados por los líderes fueron la homosexualidad, la prostitución, la promiscuidad, y el abuso de substancias que están en la contradicción directa con sus creencias y ensenanzas. Los líderes sentían que estas conductas de riesgo se hallaban exacerbadas por los cambios en la estructura de la familia y la ausencia de un discurso moral común compartido por todos los sectores de la sociedad. CONCLUSIÓN: La comunidad de fe tiene una presencia significativa en toda Granada y puede ser un aliado eficaz a la hora de ayudar a las comunidades a entender y prevenir el VIH/SIDA, así como a superar el estigma y la discriminación asociados con esta enfermedad. Se necesitan entrenamiento y estrategias efectivas para comprometer a las comunidades de fe a una respuesta nacional frente al VIH/SIDA, sin amenazar sus prácticas e ideologías.