Educating Church Congregation Members About Diabetes Yields Positive Results
Meizi He, MD, PhD, MSc
Nutrition and health researcher at The University of Texas at San Antonio
American Diabetes Association Research Funding
Innovative Clinical Research
There’s lots of research on the effectiveness of using a church—as opposed to, say, a hospital—to teach people with diabetes the skills they need to manage their disease. Typically, professional diabetes educators offer classes in diabetes self-management to church members, who find their regular place of worship a familiar and comfortable setting. Researcher Meizi He, MD, PhD, MSc, of The University of Texas at San Antonio calls this “faith-placed” education. The approach has been widely tested in African American churches, where some studies suggest it improves adherence better than diabetes self-management classes held at hospitals or doctors’ offices.
He works in San Antonio, where diabetes is a particularly challenging problem among the city’s majority-Latino population. “The [Latino] community is disproportionately affected by the disease,” says He. Nearly 15 percent of Latinos in the United States have diabetes, 50 percent higher than the general U.S. population. “Particularly in low-income areas, they have limited access to health care, there’s a language barrier, and there’s limited access to healthy food.”
There was another statistic that spiked He’s interest: Over 90 percent of Latinos in the United States are affiliated with a church. That, she reasoned, would make churches great places to deliver health education. “We were looking for platforms to reach the target audience,” she says.
He wondered if classes incorporating Christian themes and taught by church members—what she calls “faith-based” education—might deliver more lasting results than faith-placed education. “We wanted to test the hypothesis that integration of faith is more effective than outside people coming to the church,” she says.
With the help of a grant from the American Diabetes Association (ADA), He designed an intervention called “Building a Healthy Temple,” based on the well-known biblical verse from 1 Corinthians: “Do you not know that your bodies are temples of the Holy Spirit?”
After creating the intervention, He approached churches and recruited church members, typically the congregations’ lay members who had diabetes, to act as instructors. They were given a 40-hour training course and returned to their churches to deliver the same diabetes self-management support curriculum taught by professional diabetes educators, along with a sermon on health and seven sessions of health-oriented Bible study. “We try to connect diabetes to faith and scripture,” says He. “The message is people should maintain the temple not for themselves, but because it’s God’s temple—and you’d better take care of God’s temple.”
To see if her curriculum was more effective, He had to find a way to compare church-based health education classes given by diabetes educators with “Healthy Temple” classes given by church members. To do so, she found similar churches and paired them up, offering a Healthy Temple class in a large Catholic church and a regular diabetes education class in another Catholic church across town, for example.
The analysis compared the A1Cs of people who participated in classes run by members of their church to the A1Cs of those who took classes delivered by certified diabetes educators. Her initial results were encouraging: The groups run by church members managed to lower their A1Cs significantly by the year mark, and they kept their blood glucose levels close to or within target range for a full year after the classes ended. The same benefit wasn’t seen in the other groups.
The Bible-oriented classes were enthusiastically received. “People didn’t see it as health education. They saw it as part of their faith practice,” says He. “You can see the faith-based participants really liked it. People feel they’re doing it for a higher purpose.”
There’s another factor at work, too. Even after the classes are over, participants stay in contact with other members of the group and their lay instructors, who are all fellow members of the congregation. “There’s integration and ongoing support,” says He. “People feel comfortable going to church and supporting each other.”
And, says He, the community-based setting makes it easier to spread the message about diabetes management to the families and friends of those with diabetes. “Daughters and sons come to the classes to learn to support their parents,” she says. “It’s the beauty of a community-based program.”
Combining faith and health wasn’t without complications. One question He, herself a devout Christian, had to navigate was finding a way to connect caring for diabetes to respecting God, particularly for people who developed type 2 diabetes later in life. She was concerned, for example, that people with type 2 might see their disease as divine punishment for not caring for God’s temple. “The program frames it in a positive way,” she says. “You can honor God and move forward.”
So far, He’s results are in the research stage; she presented them at a recent ADA conference and is applying for funding to turn her research into a curriculum that could be adopted by churches nationwide and accredited by the ADA.
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