Introduction
This community-based participatory research pilot study explored multilevel perceptions and strategies for developing future faith-based organization blood pressure interventions for young black men.
Methods
Community partners recruited the sample through two, southeastern U.S. urban churches as potential intervention hubs; academic partners conducted phone interviews with church leader key informants, and three focus groups with black men aged 18–50 years. Qualitative content analysis helped generate themes from: key informant questions assessing organizational assets and capacities, and factors influencing participation; and focus group questions assessing lifestyle and self-management behaviors. Questions assessing themes on blood pressure intervention strategies were asked. Data were collected in 2016 and analyzed in 2016–2017.
Results
The sample included 21 key informants and 19 young black men. Key informants’ leadership experience averaged 16.6 (SD=12.1) years and 28.6% were male. Focus group participants were primarily single (55.6%), college educated (61.1%), and employed (77.8%). Mean blood pressure was 131.1 (SD=15.3)/79.5 (SD=11.2) mmHg, 33.3% self-reported having hypertension, 88.9% report a family history of hypertension, and 88.9% see a provider annually. For key informants, young black men lack understanding of hypertension despite available resources, and pastors are important role models and advocates. For focus group participants, hidden sodium and stressful, busy schedules impact lifestyle behaviors; and church support for busy schedules are important. Common strategies included incentive-laden, activity-integrated programs, and male social context (testimonials, peer mentoring, engagement outside of the church).
Conclusions
Findings and lessons learned will help design future community-based participatory research, faith-based organization–led blood pressure interventions relevant to young black men.
Supplement information
This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.
INTRODUCTION
Black men have earlier onset of hypertension (HTN) and greater HTN-related comorbidities and mortality than whites and black women.
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They are less likely to engage in healthcare-seeking, self-management, and lifestyle behaviors than whites.3
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Interventions for increasing the lifespan of young black men aged 50 years and older are limited.8
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Faith-based organizations, or churches, represent viable settings and distinct infrastructures for community-based participatory research interventions for blacks.10
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This community-based participatory research pilot study: (1) explored church organizational capacity to lead blood pressure (BP) interventions in young black men, and (2) identified multilevel perceptions and strategies for future BP interventions in young black men.METHODS
The Center for Healthy African American Men through Partnerships collaboratively develops, implements, and evaluates interventions to improve black men's health through national, community-partnered research, outreach, and training (https://chaamps.com/). For this study, the University of Alabama at Birmingham (UAB) researchers partnered with the National USA Foundation, Inc., which provides fiscal and programmatic support for the National Baptist Convention USA, Inc. (NBCUSA; www.nationalbaptist.com/).
National USA Foundation, Inc. and UAB identified two NBCUSA member churches, in Alabama and North Carolina, as potential intervention hubs based on: the pastors’ NBCUSA leadership and influence, church membership size (>2,000), percentage of men in church membership (≥40% men and ≥60% of men aged 18–54 years), presence of nurse-led health ministries, regular health-related events, and information/education programs. The study team included National USA Foundation, Inc. and UAB investigators, pastors, and three community coordinators: volunteer deacon and registered nurse health ministry leaders and a paid, full-time registered nurse.
Study Population
The pastors and community coordinators identified 30 potential key informant (KI) church leaders. Community coordinators selected focus group (FG) participants by screening a purposive sample of 40 black men, aged 18–50 years, living in the church metropolitan area, and meeting at least one of the following: self-reported having HTN or family history of HTN, or screening BP measured as pre-HTN (systolic BP [SBP] >120 to <140 mmHg and/or diastolic BP [DBP] >80 to <90 mmHg) or HTN (SBP ≥140 mmHg and/or DBP ≥90 mmHg).
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Measures
KIs, in 20- to 45-minute phone interviews, shared perceptions on church organizational capacity and young black men–focused BP intervention feasibility; they received $25 for participating. FGs, in 60- to 90-minute sessions, captured young black men's HTN-related lifestyle barriers/facilitators and BP intervention strategies.
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One facilitator and one note taker conducted three sessions (one for individuals aged 18–35 years, two for individuals aged 36–50 years), obtaining consent and demographic information. Attendance challenges prohibited a fourth session and resulted in an interview of one man aged 18–35 years. Men received $20 for participating. KI interviews and FGs were digitally recorded and transcribed (Table 1).Table 1KI and FG Core Questions
| Questions |
|---|
| KI questions |
| Organizational assets and capacities |
| What is the involvement of young black men in participating in health promotion activities (in general, and HTN-specific)? |
| What have been your church's efforts to engage young black men in church (in general, and in efforts related to CVD/HTN health)? |
| Factors influencing participation |
| What influences the decision for your church to participate/implement a health program? Does it matter who suggests it? |
| What would need to be done to be sure that young black men actually participate? |
| Intervention strategies |
| What types of resources would need to be acquired for such a program? |
| What is the role of the church leadership, especially the pastor? |
| What should be the role of women in implementing a health program for young black men? (Should women be involved? If so, in what way?) |
| FG questions |
| Lifestyle and self-management behaviors |
| Lifestyle modifications to prevent high BP include: |
| Reducing weight—maintaining a normal body weight (BMI 18.5–24.9) |
| Eating a diet rich in fruits, vegetable, and low-fat dairy; less saturated and total fats |
| Reducing salt intake to 2.4 g or less than 1/2 teaspoon/day |
| Engaging in regular aerobic physical activity at least 30 minutes/day at least 5 days a week |
| Limiting alcohol consumption to no more than 2 drinks/day |
| Eating enough dietary potassium (3.5 g/day, which is about 1 banana/day) |
| How easy or hard is it for young black men to practice these lifestyle factors? |
| How could your church help black men engage in these lifestyle behaviors? |
| Behaviors for controlling BP include: |
| Using BP medications |
| Monitoring your BP at home |
| Going to the doctor regularly |
| How easy or hard is it for young black men to practice these behaviors? |
| How could a church-supported program help young black men practice these behaviors? |
| Intervention strategies |
| What are other issues that may contribute to preventing or controlling BP that should be considered for a church-based intervention with young black men? |
| In designing a church-based intervention: |
| Who should be involved? |
| What kinds of resources are needed? |
| Who should run it? |
| How would you ensure participation? |
| What are the most important activities that should be included? |
BP, blood pressure; CVD, cardiovascular disease; FG, focus group; HTN, hypertension; KI, key informant.
Statistical Analysis
Data were collected February 2016 through May 2016 and analyzed August 2016 through January 2017. Rapid assessment procedure-trained study team members, using inductive, team-based content analysis,
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coded and consolidated transcript units, exploring individual and collective thematic patterns from interview and FG transcript texts., 28
After independently identifying themes, two reviewers per transcript further refined themes, using an adjudicator for one transcript unit. The UAB IRB approved this study.RESULTS
The authors interviewed 21 (70%) KIs (Table 2). KIs had approximately 16–17 years of leadership experience. Although having similar represented roles, one church had more ministerial staff; the other had more deacons. Unreached KIs were primarily men with persistent scheduling conflicts.
Table 2Characteristics of KI and FG Participants, by Site
| Characteristics | Total | Site 1 | Site 2 |
|---|---|---|---|
| KI participants | |||
| Attempted to contact, n | 30 | 15 | 15 |
| Total participated, n | 21 | 12 | 9 |
| Gender, n (%) | |||
| Female | 15 (71.4) | 8 (66.7) | 7 (77.8) |
| Male | 6 (28.6) | 4 (33.3) | 2 (22.2) |
| Years in leadership role | |||
| M ± SD | 16.6 ± 12.1 | 22.0 ± 10.9 | 9.3 ± 9.9 |
| Range | 1–39 | 7–39 | 1–33 |
| Role in church, n (%) | |||
| Pastor (senior or associate) | 4 (19.0) | 3 (25.0) | 1 (11.1) |
| Ministerial staff (men's ministry, outreach ministry, etc.) | 5 (19.0) | 1 (8.3) | 4 (44.4) |
| Deacon or Deaconess | 7 (38.0) | 7 (58.3) | 0 (0.0) |
| Administrative or facilities staff | 4 (19.0) | 1 (8.3) | 3 (33.3) |
| Board of Trustees | 1 (4.0) | 0 (0.0) | 1 (11.1) |
| Total who did not participate | 9 | 3 | 6 |
| Reasons for not participating, n (%) | |||
| Scheduled but unable to participatein study timeframe | 2 (22.2) | 2 (66.7) | 0 (0.0) |
| Declined due to other commitments | 3 (33.3) | 1 (33.3) | 2 (33.3) |
| Not reached | 3 (33.3) | 0 (0.0) | 3 (50.0) |
| Inaccurate contact information | 1 (11.1) | 0 (0.0) | 1 (16.7) |
| FG participants | |||
| n | 19 | 14 | 5 |
| Age, years, n (%) | |||
| 18–35 | 9 (47.4) | 8 (57.1) | 1 (25.0) |
| 36–50 | 10 (52.6) | 6 (42.9) | 4 (75.0) |
| Marital status, n (%) | |||
| Single, never married | 10 (55.6) | 8 (61.5) | 2 (40.0) |
| Married | 6 (33.3) | 4 (30.8) | 2 (40.0) |
| Separated/divorced | 2 (11.1) | 1 (7.7) | 1 (20.0) |
| Education, n (%) | |||
| ≤High school | 2 (11.1) | 2 (15.4) | 0 (0.0) |
| Some college | 5 (27.8) | 3 (23.1) | 2 (40.0) |
| Associate's or bachelor's degree | 7 (38.9) | 5 (38.5) | 2 (40.0) |
| Graduate or professional degree | 4 (22.2) | 3 (23.1) | 1 (20.0) |
| Employment status, n (%) | |||
| Employed | 14 (77.8) | 10 (76.9) | 4 (75.0) |
| Unemployed, retired, or other | 4 (22.2) | 3 (23.1) | 1 (25.0) |
| Annual household income, n (%) | |||
| <$20,000 | 3 (16.7) | 2 (15.4) | 1 (20.0) |
| $20,000–$39,999 | 5 (27.8) | 4 (30.8) | 1 (20.0) |
| ≥$40,000 | 10 (55.6) | 7 (53.8) | 3 (60.0) |
| Household size, adults (≥19 years), n (%) | |||
| 1 adult | 5 (27.8) | 3 (23.1) | 2 (40.0) |
| 2 adults | 9 (50.0) | 8 (61.5) | 1 (20.0) |
| 3 or more adults | 4 (22.2) | 2 (15.4) | 2 (40.0) |
| Household size, children (<19 years), n (%) | |||
| 1 child | 2 (11.1) | 2 (15.4) | 0 (0.0) |
| 2 or more children | 4 (22.2) | 3 (23.1) | 1 (20.0) |
| Clinical values, M ± SD | |||
| Weight, lb | 212.9 ± 57.8 | 193.4 ± 33.3 | 267.4 ± 79.1 |
| BMI, kg/m2 | 33.6 ± 12.0 | 29.0 ± 5.4 | 46.2 ± 16.8 |
| SBP, mmHg | 131.1 ± 15.3 | 128.7 ± 16.2 | 137.6 ± 11.4 |
| DBP, mmHg | 79.5 ± 11.2 | 78.4 ± 9.4 | 82.4 ± 16.1 |
| Perceived health status, n (%) | |||
| Poor/fair | 2 (11.1) | 1 (7.7) | 1 (20.0) |
| Good | 12 (66.7) | 9 (69.2) | 3 (60.0) |
| Very good/excellent | 4 (22.2) | 3 (23.1) | 1 (20.0) |
| Family member(s) diagnosed with HTN, n (%) | 16 (88.9) | 12 (92.3) | 4 (80.0) |
| Told by a doctor they have HTN, n (%) | 6 (33.3) | 3 (23.1) | 3 (60.0) |
| Prescribed medications | 2 (11.1) | 2 (15.4) | 0 (0.0) |
| See a healthcare provider at least once a year, n (%) | 16 (88.9) | 11 (84.6) | 5 (100.0) |
| Health insurance, n (%) | 17 (94.4) | 12 (92.3) | 5 (100.0) |
| Tobacco use, n (%) | 1 (5.6) | 1 (7.7) | 0 (0.0) |
| Alcohol use (<2 drinks per week), n (%) | 10 (55.6) | 8 (61.5) | 2 (40.0) |
a A total of 19 men anonymously completed the demographic form. Age, height, weight, and BP were recorded for all 19 FG attendees. However, one attendee did not complete the remainder of the demographic form, leaving a sample size of 18 for all other variables.
b An interview was conducted with a black male aged 35–50 years at Site 2 in lieu of an FG due to only one person in attendance.DBP, diastolic blood pressure; FG, focus group; HTN, hypertension; KI, key informant; SBP, systolic blood pressure.
Churches’ support services and activities, such as Brotherhood Ministry, annual health fairs, and fellowship outings (e.g., historically black college football games), enhance men's spiritual and social needs (Table 3). However, young men are present but not traditionally targeted: “. . . if someone is not talking to them individually about it, it is probably not happening for them.”
Table 3KIs: Key Themes and Selected Quotes
| Theme | Description | Selected supporting quotes |
|---|---|---|
| Organizational assets and capacities | ||
| Support services and activities | The parish nurse and men's brotherhood network provide support to men. | . . . she [parish nurse] speaks on the podium and during the services on certain health things that are going on. . . . Even things that are going on in the city that, you know, members might want to attend. . . . I think that she's an excellent resource for us. . . . (KI, Site 2) . . . they do have a men's ministry called the Brotherhood. They have varying, I guess, programs to try to bring young men together for spiritual purposes. . . and then they do have the health symposium to try to engage men of all ages. (KI, Site 2) |
| Present but not traditionally targeted | Men aged 18–50 years are in churches, but health programs do not specifically target them. | We have a good population of young adults. But because there is not a health ministry per say that focuses on this . . . if someone is not talking to them individually about it, it is probably not happening for them. (KI, Site 1) |
| Lack of understanding despite available resources | Health ministries have HTN-related activities and resources, but men do not understand the risks involved with HTN. | I really don't think black men understand it is as critical a health issue as it is. So there's a void of understanding of what hypertension is, the causes of hypertension and then how we can do better maintenance with this silent killer. . . . Younger black men feel that they're fine and fit and don't really think about it. . . . So we may be dizzy and we'll sit down for half an hour and keep on going rather than going to the doctor. (KI, Site 1) |
| Factors influencing participation | ||
| Pastor as advocate and role model | Senior pastors of the churches already serve as role models and advocates for healthy living. Their endorsement is critical. | And he [the pastor] does participate with the men as far as the sessions and all. He is into health. He exercises every day. He walks every day as well. So he is very health conscious, diet conscious. He talks to us about it. (KI, Site 2) So I think you got to set that tone and set that vision of hey, here's what I endorse and maybe even here's why. And then encourage all of us if you will to say okay I like to be involved in doing this. . . . (KI, Site 1) |
| Busy schedules | Time is a precious commodity for busy men to invest additional time in church-sponsored health activities. | I think you need to do it when they have a natural gathering rather than creating a new venue. (KI, Site 2) |
| Role of women | Women may attract them to participate. | . . . the women are probably a really big influence . . . making sure that the women are aware that, hey, these are important issues and to encourage your son, husband . . . father or whatever. I think they can just be maybe a bigger catalyst than some of the leaders. . . . (KI, Site 2) |
| Intervention strategies | ||
| Leadership advocacy | The pastor, men, members who are health professionals, and church leadership should support the program. Whether through endorsement, invitation to participate, or implementing activities. | There is this unspoken order. . . . If the pastor says it, it is like gold. My pastor is an information person. And the more information you can provide, the better chance that you can [get a program approved]. (KI, Site 1) I would have a panel of different physicians talking about some of the problems within black men through doctors. And we have physicians in the church that could probably do that—men. (KI, Site 2) |
| Prayer and scripture | Prayer should be used to encourage good health decisions, and scripture should be used to reinforce establishing/maintaining healthy behaviors. | I think you have to find a way initially to talk in terms of spirituality in a safe walk and be broad in that and not feel that this has to be an evangelical gathering. . . . There is certain scripture that says you should—how you should take care of yourself and I think you should encourage that . . . the minister can bring it up in sermons and definitely you can bring it up in prayer. (KI, Site 2) |
| Purposive setting, timing, and scheduling | Program should be integrated with existing men's activities, using a range of options of flexible times, and in convenient trustworthy locations outside of the churches. | I think we need to be honest and deal with the facts of black men in health . . . creating a venue where young black men feel welcomed. They don't feel threatened and it's an environment that they can enjoy. (KI, Site 2) . . . actually make it useful at any time whether it be Wednesday night services, whether it be Sunday morning service, whether it be Sunday School service, or just a regular fellowship in between the hours. (KI, Site 1) |
| Integration within existing social context | Involve the sphere of influence around them, including family, and weave into the fabric of the church to help reduce conflicts of responsibility. | I think the appeal needs to be made directly to the young men but in addition to those who are—care for them and are concerned about them so I think the appeal again, may be made to the participant but also to family members, to those who might have some concern about these male issues. (KI, Site 2) |
| Role of women should be acceptable to the men | Some feel men should design and implement the program, but others feel women should be fully involved. | Brothers should plan it. I don't want a sister to plan it for the brothers. Get the brothers together and get two or three of them to plan it. (KI, Site 2) I think they should be involved in the whole process because some folks do not feel comfortable as they feel with women who they feel comfortable talking to. (KI, Site 1) |
| Technology and social media | Use technology, texts, and various social media applications to reach busy men who are on the go. | We have the resource of the utilization of great technology within the church. We just got to utilize it in a more efficient way. And I think if we had someone to push the health initiative on the media it could become a great resource. (KI, Site 1) |
| Testimonials and peer mentoring | Include real-world testimonies and success stories from men who have improved their blood pressure and weight, one-to-one peer mentoring, and black male physician discussions at church forums, barbershops, or other community venues. | I think it's critical to have peer witnessing and testimonials. A younger man thinks an older man, well he's old, and I'm not 50. But when you get a 37 talking to 20s to 50s and say I'm close to 37, I just passed, I'm 40, hey I'm in this group and the brother is talking to me. I find that that has been more effective in reaching that group than someone older or someone who has not had an actual experience in what we're talking about as a testimonial witness. (KI, Site 2) |
a Theme also emerged with focus group participants.HTN, hypertension; KI, key informant.
Senior pastors may be advocates and role models (Table 3): “[The pastor] does participate with the men. . . . He is into health. He exercises every day . . . he is very health conscious. . . . He talks to us about it.”
Busy schedules and roles of women may also influence participation. Men will prioritize participation if activities occur within natural gatherings, rather than “new venues,” and women serve as motivators for action.
Of the 40 men screened, 20 were ineligible (19 not meeting screening criteria; one post-screening decline), leaving a study sample of 19 men, nine were aged 18–35 years and ten were aged 36–50 years (Table 2). Most were single or never married, employed, and college educated. One-third self-reported being diagnosed with HTN, and almost 90% reported a family history of HTN.
Most lifestyle behaviors were deemed manageable. However, stress existed in managing busy work- and family-related schedules for men aged 36–50 years, and college and work responsibilities for men aged 18–35 years. Understanding hidden sodium was also a prevailing theme (36–50 group; Table 4): “I used to think it was just sprinkling salt on your food, but so much is just in there, almost in everything you buy prepackaged, there's just tons of salt.”
Table 4FG Participants: Key Themes and Selected Quotes
| Theme | Description | Selected supporting quotes |
|---|---|---|
| Lifestyle and self-management behaviors | ||
| Understanding hidden sodium | The capacity for lifestyle modification is difficult because of hidden sodium in foods. | I used to think it was just sprinkling salt on your food, but so much is just in there, almost in everything you buy prepackaged, there's just tons of salt. (FG, Site 2) . . . when I found out I had hypertension I basically changed my diet, my lifestyle. . . . diet was difficult before, it is easy now . . . a lot of the people my age, they are not used to it, it is a shellshock. It is a lifestyle change so it is hard because you are used to eating all that good food and then when you have to say, “Well, no salt, got to cut back on,” and even certain kinds of food. It is really hard because you have been eating it all your life. It is a change. . . . When you are talking about your health, it is not just for one day it is from here on out. (FG, Site 1) |
| Busy schedules | Time is a precious commodity for busy men to invest additional time in church to address their health. | . . . especially in that age group, 35 to 50, everybody, it's hard to maintain [healthy behaviors] because of your schedule. (FG, Site 2) |
| Intervention strategies | ||
| Establish need for the program | A person of authority or a critical mass must establish a need before men choose to participate. | . . . young black men just need to see success. (FG, Site 2) |
| Role of women | Women may attract them to participate. | Looking better improves self-confidence in dealing with women. (FG, Site 1) |
| Prayer and scripture | Prayer and meditation should be used to encourage good health decisions; scripture should be used to reinforce and maintain healthy behaviors. | I do not want to say praying for help, but prayer to make good decisions about our bodies, the way we treat our bodies, how we want to live our lives because the scripture does say the body is a temple, you should treat it as such. I think that would definitely be in there and use the scripture to reinforce what we are trying to do. (FG, Site 2) |
| Sporting activities | Basketball events at the church and football and basketball outings, such as half-time information sharing, and game-day watches at friends’ homes keep men active and connected. | I think for my age group, sports for some, I mean it is, it is a good thing because everybody is geared toward it. Everybody is geared toward it especially after black men; we are well geared toward it. Especially Saturday games, college football, black college football and then as well as big college football. That would be the time to do it because you would get a big group together so that would be a perfect time to talk about it, like before the game, halftime and even after the game. (FG, Site 1) |
| Monetary incentives | Incentives are important for including and retaining men in programs. | See, church is all about donation and giving. That is cool but I come from the business world. . . . When you make this a business, that is when we are going to get healthier. (FG, Site 1) |
| Incentive-laden program content | Program should include incentives such as women, food, friendly competition with prizes/awards to reward and display successes. | Put girls in the program because they feel like they would have this incentive to want to do better in their physical activity because they are driven as physical creatures and so the same may occur for men 35 to 50 as well . . . (FG, Site 2) I know some churches. They may get together on Saturday to watch a football game at the church. . . . And they bring in their food and some of them gear it toward health conscious. (FG, Site 1) I do believe in that and incentives could be when you finish, whoever is lowest has to buy the lunch. Whatever person is the highest, who is the highest has to buy lunch. I guess it is that kind of competitiveness. But then again, it is a good competitiveness because you are doing something that is healthy for you. (FG, Site 1) |
a Theme also emerged with key informants.FG, focus group.
KIs mentioned church male leadership advocacy by the pastor, other leaders (e.g., deacons, heads of ministries), and integrating activities with existing church and family activities (integration within existing social context) as intervention priorities (Table 3). FG participants conveyed monetary incentives (e.g., $50/session) and incentive-laden program content (e.g., rewards for achieving health goals) as key strategies (Table 4). KIs and FG participants viewed roles of women and prayer and scripture as strategic priorities. Although KIs described women's roles as designing/implementing interventions, views were mixed; most FG participants (particularly aged 18–36 years) considered women as incentives to participate as mentioned by a KI: “I don't want a sister to plan it for the brothers. Get the brothers together and get two or three of them to plan it.” Another KI said: “I think they should be involved in the whole process because some folks do not feel comfortable as they feel with women. . . .” And an FG participant said: “Looking better improves self-confidence in dealing with women.”
Prayer and scripture should be incorporated into interventions, but not be obligatory.
DISCUSSION
To the authors’ knowledge, this is the first qualitative study exploring perceptions and attitudes of black church leaders and young black men on developing faith-based BP intervention strategies. Findings confirm persistent challenges of engaging black men for interventions.
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However, results imply that programs should keep church infrastructures and men's busy schedules in mind when recruiting and disseminating/implementing health information. Prayer and scripture, supportive family networks, women, church leaders, mentors, and peers may help young black men increase their knowledge and optimal BP-related lifestyles. Program strategies should foster environments30
that provide young black men with tools, including success stories from men of faith who have adopted better eating habits, to make alternate food choices, including those considering hidden sodium.Limitations
Results may be not generalizable to other black church leaders and young men in the NBCUSA. Although these large, metropolitan churches have resources, serving as hubs for future interventions requires a better understanding of resources needed and methods that link external activities of young black men. Roles of smaller, less-resourced churches with potentially greater needs/interests and less competing priorities may need to be considered.
CONCLUSIONS
This study provides useful information for designing future BP interventions targeting church leaders and young black men. The project team will be able to build on the lessons learned in developing protocols for reaching out to other churches to implement relevant, evidenced-based approaches.
ACKNOWLEDGMENTS
Publication of this article was supported by a grant from the National Institute on Minority Health and Health Disparities, National Institutes of Health [grant number U54MD008620]. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the National Institute on Minority Health and Health Disparities or the National Institutes of Health.
The authors would like to thank the pastors, church leaders, and the staff at the participating churches who helped implement this study, along with the key informants and focus group participants.
Dr. Redmond contributed to this article as an employee of the University of Alabama at Birmingham. The views expressed are her own and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; NIH; or HHS.
Lori Carter-Edwards has no conflicts of interest. While an employee of the University of North Carolina at Chapel Hill, she served as a paid consultant to the National USA Foundation, Inc. for this study. No other financial disclosures were reported by the authors of this paper.
SUPPLEMENT NOTE
This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.
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This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy, which is sponsored by the NIH.
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© 2018 American Journal of Preventive Medicine. Published by Elsevier Inc.
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