This study describes a community-based participatory research (CBPR) approach to design a novel faith-enhancement to the diabetes prevention program (DPP) for AA women. A long-standing CBPR partnership designed the faith-enhancement from focus group data. The faith components were specifically linked to weekly DPP learning objectives to strategically emphasize behavioral skills with religious principles. Using a CBPR approach, the Better Me Within trial was able to enroll 12 churches, screen 333 AA women, and randomize 221 after collection of objective eligibility measures. A prospective, randomized, nested by church, design was used to evaluate the faith-enhanced DPP as compared to a standard DPP on weight, diabetes and cardiovascular risk, over a 16-week intervention and 10-month follow up.
Reducing obesity positively impacts diabetes and cardiovascular risk; however, evidence-based lifestyle programs, such as the diabetes prevention program (DPP), show reduced effectiveness in African American (AA) women. In addition to an attenuated response to lifestyle programs, AA women also demonstrate high rates of obesity, diabetes, and cardiovascular disease. To address these disparities, enhancements to evidence-based lifestyle programs for AA women need to be developed and evaluated with culturally relevant and rigorous study designs. This study describes a community-based participatory research (CBPR) approach to design a novel faith-enhancement to the DPP for AA women. A long-standing CBPR partnership designed the faith-enhancement from focus group data (N=64 AA adults) integrating five components: a brief pastor led sermon, memory verse, in class or take-home faith activity, promises to remember, and scripture and prayer integrated into participant curriculum and facilitator materials. The faith components were specifically linked to weekly DPP learning objectives to strategically emphasize behavioral skills with religious principles. Using a CBPR approach, the Better Me Within trial was able to enroll 12 churches, screen 333 AA women, and randomize 221 (Mean age =48.8 ±11.2; Mean BMI =36.7 ±8.4; 52% technical or high school) after collection of objective eligibility measures. A prospective, randomized, nested by church, design was used to evaluate the faith-enhanced DPP as compared to a standard DPP on weight, diabetes and cardiovascular risk, over a 16-week intervention and 10-month follow up. This study provides essential data to guide enhancements to evidence-based lifestyle programs for AA women who are at high risk for chronic disease.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
221
The faith-enhanced curriculum was faith-based and developed using CBPR approaches. The Faith-DPP condition included delivery of the DPP. The group intervention was delivered by one to two trained peers from the church and consisted of 16 weekly group meetings followed by 6 bi-monthly or monthly maintenance sessions. The faith enhanced curriculum included five strategies: 1) a mini sermon (\~15 min in length) delivered by a pastor (head pastors were required to deliver at least one per month), first lady, or church leader (pastor associate, deacon, elder, etc.), 2) a memory verse, 3) in class or take-home faith activity (application of faith principles), 4) promises to remember, and 5) scripture and prayer integrated into participant curriculum and facilitator materials. These five faith enhancements were developed by the CAB to enhance the DPP's weekly learning objectives, which resulted in faith components specifically linked to each week of DPP content.
The S-DPP condition was faith-placed, a secular program (the DPP) held at an faith-based organization. This condition received the same diabetes prevention program (DPP) as the Faith-DPP, but did not receive any faith enhancements or pastor involvement.
UNT Health Science Center
Fort Worth, Texas, United States
Body weight
Weight (lbs) was collected with a digital scale in light clothing with shoes removed. Weight was collected twice and the average was computed. Height was also measured using the same protocol to calculate the BMI (body-mass index).
Time frame: Baseline
Body weight
Weight (lbs) was collected with a digital scale in light clothing with shoes removed. Weight was collected twice and the average was computed. Height was also measured using the same protocol to calculate the BMI (body-mass index).
Time frame: 4-month
Body weight
Weight (lbs) was collected with a digital scale in light clothing with shoes removed. Weight was collected twice and the average was computed. Height was also measured using the same protocol to calculate the BMI (body-mass index).
Time frame: 10-month
Waist circumference: Number of participants above the recommended level
Waist circumference was taken at the top of the pelvis (e.g., above the uppermost lateral border of the right ilium) with a measuring tape twice and averaged.
Time frame: Baseline
Waist circumference: Number of participants above the recommended level
Waist circumference was taken at the top of the pelvis (e.g., above the uppermost lateral border of the right ilium) with a measuring tape twice and averaged.
Time frame: 4-month
Waist circumference: Number of participants above the recommended level
Waist circumference was taken at the top of the pelvis (e.g., above the uppermost lateral border of the right ilium) with a measuring tape twice and averaged.
Time frame: 10-month
Fasting glucose
Fasting glucose was measured with the Cholestech LDX system
Time frame: Baseline
Fasting glucose
Fasting glucose was measured with the Cholestech LDX system
Time frame: 4-month
Glycated Hemoglobin A1c
Glycated hemoglobin A1C was measured with Bayer A1c Now + Multi-Test A1c System.
Time frame: Baseline
Glycated Hemoglobin A1c
Glycated hemoglobin A1C was measured with Bayer A1c Now + Multi-Test A1c System.
Time frame: 4-month
Low-density lipoprotein cholesterol (LDL)
LDL was measured with a fasting blood sample obtained by finger stick with the Cholestech LDX system
Time frame: Baseline
Low-density lipoprotein cholesterol (LDL)
LDL was measured with a fasting blood sample obtained by finger stick with the Cholestech LDX system
Time frame: 4-month
High-density lipoprotein cholesterol (HDL)
HDL was measured with a fasting blood sample obtained by finger stick with the Cholestech LDX system.
Time frame: Baseline
High-density lipoprotein cholesterol (HDL)
HDL was measured with a fasting blood sample obtained by finger stick with the Cholestech LDX system.
Time frame: 4-month
Blood pressure
Blood pressure was collected with an automated blood pressure device following a seated 5 min rest in a quiet area. Two measurements were taken following Eighth Joint National Committee protocols and averaged.
Time frame: Baseline
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Blood pressure
Blood pressure was collected with an automated blood pressure device following a seated 5 min rest in a quiet area. Two measurements were taken following Eighth Joint National Committee protocols and averaged.
Time frame: 4-month
Blood pressure
Blood pressure was collected with an automated blood pressure device following a seated 5 min rest in a quiet area. Two measurements were taken following Eighth Joint National Committee protocols and averaged.
Time frame: 10-month
Dietary patterns: Total energy (Kcal), total fat (gram), total sodium (milligram) intake on a typical day
Diet was measured with the Lower Mississippi Delta Nutrition Intervention Research Initiative (Delta NIRI) food frequency questionnaire. Data is scanned and analyzed by Northeastern University's Dietary Assessment Center. Total energy, fat, sodium, and other dietary components were estimated from the questionnaire. Desired total energy (Kcal) (range: 500 to 10,000) intake is defined as 2000 Kcal or less. Desired fat (gram) (range: 10 to 500) intake is defined as 77 gram or less. Desired sodium (milligram) (range: 100 to 20,000) intake is defined as 2300 milligram or less.
Time frame: Baseline
Dietary patterns: Total energy (Kcal), total fat (gram), total sodium (milligram) intake on a typical day
Diet was measured with the Lower Mississippi Delta Nutrition Intervention Research Initiative (Delta NIRI) food frequency questionnaire. Data is scanned and analyzed by Northeastern University's Dietary Assessment Center. Total energy, fat, sodium, and other dietary components were estimated from the questionnaire. Desired total energy (Kcal) (range: 500 to 10,000) intake is defined as 2000 Kcal or less. Desired fat (gram) (range: 10 to 500) intake is defined as 77 gram or less. Desired sodium (milligram) (range: 100 to 20,000) intake is defined as 2300 milligram or less.
Time frame: 4-month
Physical activity: Total number of active minutes per week
Physical activity was measured by self-report with the Past Week Modifiable Physical Activity Questionnaire. A total of all physical activity minutes was calculated from the questionnaire. Desired level of physical activity is defined as 150 minutes or more per week.
Time frame: Baseline
Physical activity: Total number of active minutes per week
Physical activity was measured by self-report with the Past Week Modifiable Physical Activity Questionnaire. A total of all physical activity minutes was calculated from the questionnaire. Desired level of physical activity is defined as 150 minutes or more per week.
Time frame: 4-month
Physical activity
Physical activity was measured by self-report with the Past Week Modifiable Physical Activity Questionnaire. A total of all physical activity minutes was calculated from the questionnaire. Desired level of physical activity is defined as 150 minutes or more per week.
Time frame: 10-month
Estradiol (pg/mL)
Saliva collected in 4 consecutive weeks and sent to a laboratory to assay
Time frame: Baseline
Estradiol (pg/mL)
Saliva collected in 4 consecutive weeks and sent to a laboratory to assay
Time frame: 4-month
Cortisol (ng/mL)
Fasting morning saliva sent to a laboratory to assay
Time frame: Baseline
Cortisol (ng/mL)
Fasting morning saliva sent to a laboratory to assay
Time frame: 4-month