Community Engagement Models:  A Broad-brush Rural Congregational

Health Initiative

National Organization of the State Offices of Rural Health

Reverend Andrea LomboyAugust 5, 2010

The Congregational Health ReSource, LLC (CHR) is a Judeo-Christian company and ministry devoted to improving health awareness from the perspective of “body, soul (mind, will, and emotions), and spirit” from a BIBLICAL approach.

“Our desire is to bring together the promise of medicine with the power of faith to lessen the gap between the

secular and the sacred, increasing synergies and infusing the potential to build healthier communities.”

DefinitionCongregational health is the focus of a congregation—an assembly of people who meet for worship and religious instruction in a designated locale—that is dedicated to being sound in body, soul, and spirit and to experiencing freedom from physical disease or pain. It unites the best practices of:

1. Public health–Protecting and improving community health through such means as applying preventive medicine, providing health education, controlling communicable diseases, and monitoring environmental hazards.

2. Faith-based principles–Relying on the belief that God is the Great Physician who has the ultimate power to heal and cure with or without the use of medical practices; using wisdom (applied knowledge) to make consensual and informed treatment decisions; turning to God-given resources such as health care providers, pharmaceuticals, hospitals, etc. as needed; and leveraging the network and support offered within the faith community.

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Introduction“The church is the only community-based

organization that is found in virtually every community in this country. It is able to reach people of all ages,

races, and economic backgrounds and it can strongly influence people’s values and personal life choices. Because the church is generally more integrated into

the life of individuals and communities than our modern medical establishment, it can better enable people to

assume responsibility for their own health.”

- Health and Welfare MinistriesGeneral Board of Global Ministries

The United Methodist ChurchNew York, New York

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“The particular faith that motivates each of us can promote a greater good for all

of us. Instead of driving us apart, our varied beliefs can bring us together to

feed the hungry and comfort the afflicted; to make peace where there is

strife and rebuild what has broken; to lift up those who have fallen on hard times.”

www.nationalserviceresources.org/links/guidance-faith-based-and-community-organizations-partnering-federal-government-pdf

www.nationalserviceresources.org

– President Barack Obama

www.flu.gov/professional/community/cfboguidance.html

Office of Faith-based & Neighborhood Partnerships

Religion, Spirituality & Public Health

FACTS to ponder (The US is a very religious nation): 93% of Americans believe in God 89% of Americans report affiliation with a religious

organization 83% of Americans say religion is fairly or very important

to them 62% of Americans say that they are members of a

church or synagogue 58% of Americans pray every day (and 75% weekly) 42% of Americans attend religious services weekly or

almost weekly (and 55% at least monthly)

democrats.science.house.gov/Media/.../2008/.../Koenig_Testimony.pdf

“If the religious congregations in America all had health programs, then two-thirds of the U.S. population would be exposed to disease detection, disease prevention, and health promotion efforts. Since persons of all ages participate regularly in religious congregations, this means that health education efforts would occur at all ages, from the young (focused on substance abuse prevention and character development) to the middle aged (focused on healthy eating, exercise, stress-reduction, etc.) to the elderly (focused on volunteering, mentoring and generative types of activities).”

–Harold M. Koenig, MD, Professor of Psychiatry & Behavioral Sciences, Associate Professor of Medicine, Duke University Medical Center

• There is every reason to suggest that religious involvement is related to better health.

• Religious beliefs, practices, and rituals are shown to improve health.

• Some research has suggested that communities where high portions of the population are members of religious groups have better health in general, even the non-religious people who live in those communities.

Public Health System

Using a Systems Approach to Address the NeedAlign Community Sectors

to Promote Health“Swiss Cheese Model” Adapted

James T. Reason BMJ 2000;320:768-770

We must align our organizations, people and resources, or we we will NEVER maximize or obtain the desired outcome for community/public health. If the gaps

in each organization align, many will fall through the holes!

This concept is a collaborative effort by A. Lomboy (CHR) and S. Triggs, (VDH OMHPHP)

Purpose

1. Identifying Community-based Leaders• Develop health/faith public-private relationships and/or partnerships

2. Identify Community-based Assets• Uncover existing programs and assets within the community from

materials to services• Educate the public about overall health issues while increasing

awareness of prevention and treatment options

3. Developing a Community-wide Congregational Health Assessment• 5 survey tools were developed (civic, clergy, education, government and

medical)• Illuminate root causes of existing health inequities, promoting social

justice that could influence changes in funding policies• Use the pilot as a framework that can be replicated in other communities

The purpose of the congregational health assessments is to advance the congregational approach to health by:

268,240 documented congregations with 176,477,348 adherents in a US

population of over 300M

*The data in these reports come from the Religious Congregations and Membership Study which is collected by the Association of Statisticians of American Religious Bodies (www.asarb.org). They collect these data by asking denominations to submit counts at the county level of congregations and membership. Some denominations choose not to participate while others simply do not have the data required to participate. The latter is the case with most African-American denominations.

**Estimated total including non-reporting congregations.

Congregations

Virginia Statistics for Congregations and Memberships

The Association of Religion Data Archives,

www.thearda.com

Members

These statistics are only for reporting churches.

46 Churches in Essex County*Please note the discrepancy.This indicates that there are MORE congregations than

even documented.

Selection ProcessThe following four counties were selected because of need and access to care challenges. They also were identified as having one or more of the following:

• Virginia Medically Underserved Area (VMUA)• Mental Health Professional Shortage (MHPSA)• Primary Care Health Professional Shortage (HPSA)• Dental Health Professional Shortage (DHPSA)

3 Critical Access Hospitals (CAH) in Virginia (out of 7)

• Bath Community Hospital, Hot Springs - Bath County• ValleyHealth Shenandoah County Hospital, Woodstock - Shenandoah

County• ValleyHealth Page Memorial Hospital, Luray - Page County

1 SHIP Hospital (out of 24) was selected:

• Riverside Tappahannock Hospital, Essex County

Surveys

Five categories of community leaders were addressed:

1. Civic–local associations and business community leaders

2. Government–local mayor, county medical director, county executives

3. Medical and health services–hospitals, clinics, health departments, private-public doctors, and other health practitioners including psychiatrists and social workers 

4. Education–principals, school counselors, school superintendents, and boards of education

5. Faith–pastors, clergy, lay leaders, congregational members

Methodology• Development of congregational health assessment tools was necessary

and developed online through SurveyMonkey.com

• 5 databases were developed for each survey type

• A tremendous amount of effort was involved in the survey!

• Methods of contact included:1. Phone2. Email3. Door-to-Door Delivery4. Direct to Community Leader5. Leader to Leader6. US Mail7. Fax

46 churches total: 8 - Civic16 - Clergy 3 - Education 5 - Government 6 - Medical*38 Completed Surveys

30 churches total: 2 - Civic6 - Clergy0 - Education0 - Government2 - Medical10 Completed Surveys

24 churches total: 2 - Civic9 - Clergy0 - Education 3 - Government7 - Medical23 Completed Surveys

Luray, Page

Woodstock, ShenandoahBath

Essex

Final Survey Findings

30 churches total: 7 - Civic9 – Clergy5 – Education2 – Government7 - Medical *30 Completed Surveys

Non-Clergy FindingsSampled secular organizations said that they could provide the following resources to local churches:

Funding Teachers (including volunteers)

Medical Personnel Facilities

Media & Advertising Partnerships

Mailings Referrals

Space Policy & Systems Change

Programs & Services Medical Equipment

Health Fairs Counseling

Training Reduced Rates

BarriersThe top barriers secular organizations face in providing products and/or services to congregations includes the following:

• Lack of information about the needs • Lack of staff and volunteers to provide services• Lack of funding• Fear of violating separation of church and state laws

In order to assist congregations, these organizations said they would need the following information in order to provide products and/or services:

• Identifying information about the congregation• A list of needs• A clear, measurable plan to show the value of their contribution

Assistance

Clergy FindingsEvery Clergy survey completed indicated that they “believed there is a connection between physical, emotional, and spiritual health.” The clergy also overwhelmingly felt that “religious institutions should play a role in helping its congregations be physically healthy.”

Nearly 80% of those who felt that way said it was, “appropriate to offer health education and health services to their congregations.”

Based on this response, the clergy were asked if they felt their congregations would use a “combination of both spiritual and medical resources to maintain and improve their health.” The same 80% “felt that they would use the resources.”Despite these findings, just over 10% said they have an active health ministry.

*For the purposes of the survey, an “active” health ministry was defined as, “A ministry of a faith-based organization that provides health care services and/or health educational classes more than once a year.”

Clergy FindingsThe following list are ways in which the various congregations currently support the health of its members:

Go with member’s to doctor’s appointments Transportation to medical appointments

Help with health-related paperwork Prayer

Provide meals Visit members who are sick

Phone calls Run a health food store

Pastoral care Pay for medical bills

Health and preventative education Support local free clinics (time & finances)

Anoint with oil Lay hands on the sick

Use the Word of God to bring encouragement and comfort

Fellowship nights that can be used to address health-related issues

Clergy FindingsTop health concerns that “your” congregation is facing:

These concerns are not surprising and are consistent with major causes of death in Virginia.

• aging • heart disease• cancer • diabetes• high costs of medications• lack of insurance• obesity • affordable health care

BarriersThe top barriers faith-based organizations face in providing products and/or services to congregations includes the following:

• #1 response - Uncertain how to start one (48.3%)• #2 response - Lack of finances and resources

- Lack of volunteers and/or leaders

• #3 response - Lack of time• Lack of health care expertise• Lack of community partnerships

The top cultural barriers that people face within their community are:

1. Racial biases2. Fear of mistreatment or unequal treatment3. Language barriers (cultural or linguistic)4. Cultural beliefs5. Perception of unequal treatment of persons

BarriersThe top health care barriers that people face in their community:

• #1 response - Lack of adequate and affordable insurance• #2 response - Lack of knowledge of resources that are available • #3 response - Lack of access to free clinics

The top socioeconomic barriers that people face in their community are:

1. Lack of sufficient income to afford basic necessities 2. Lack of transportation (public and private)3. Unemployment4. Lack of vocational training

The top social environmental barriers that people face in their community are:

• Drug abuse• Poor social support network from within the community• Housing (non-availability, non-permissive cost, low-quality)

Rural CongregationsIn our broad-brushed analysis of the four counties in the pilot, the

demographics reflect the following trend:

• Membership average of 150 • Primarily composed of senior adults with a much smaller

representation of youth and children• A predominant female majority of members • Have been in existence for more than 50 years• Have a single, salaried leadership staff• Significantly segregated• Few churches have “active” health ministries

• Nearly all of the churches felt they play a role in helping its members be healthy

• All of the churches actively support the health of its members in one way or another

Recommendations & Next Steps

• Development of a model health ministry program at a statewide level

• Health ministry toolkit/manual for congregations

• Individual church member survey

• Pilot model rural health ministry programs for congregations

• Conduct further research

Engaging the faith community in these recommendations is essential to program success. And, the development of persistent, sustained relationships with congregations are absolutely necessary.

By leveraging the strength of the faith community as a force multiplier in public

health, community capacity can be significantly increased extending its

reach, impact and value.

How can the State Office of Rural Health contribute to this effort?

Rev. Andrea Lomboyalomboy@faithbasedhealth.com

Cell: 703/581-4323