Synthesis of findings and issues from religious-based cardiovascular disease prevention trials

PURPOSE: Widespread prevention of cardiovascular disease (CVD) requires significant aggregate lifestyle behavior changes. Extensive resources including money, time, access, facilities, materials, and programs are needed to bring about such behavior changes on a large scale. Over the past several decades, funds for large scale public health efforts and related CVD research have become more difficult to acquire, and prevention efforts have been shifting to state and community sites. Thus, large scale behavior modification for CVD prevention requires active efforts to access resources from partnerships with multiple private sector organizations. METHODS: Religious organizations (ROs) are a potentially valuable channel with many advantages for undertaking behavior change programming in partnership with public health researchers. ROs have a broad direct 'reach' with people and provide social support structures, facilities, volunteers, communication channels and access to many sub-populations as well as a compatible mission and history of interest in health. In spite of the many advantages of partnerships between CVD health researchers and ROs, very few formal research studies have been conducted. Existing reports have emphasized the feasibility and powerful benefits of implementing RO-based health programs; however, little data or formal hypothesis testing have been reported. Very few formal CVD research projects have employed scientifically acceptable research designs with random assignment of intact groups to intervention and comparison conditions. RESULTS: In this review, conducted by the current authors, only six projects have been identified that meet these more rigorous scientific criteria. In a discussion of these projects, we classify RO-based studies into four levels of involvement of the RO: 1) use of ROs as sites for recruitment and tracking of experimental subjects; 2) use of RO facilities to conduct interventions; 3) involvement of RO members in delivering behavior change programs; and 4) the addition of significant religious components as an integral part of the intervention. This paper discusses the design, results and implications of these studies including information on what we already know about conducting research with ROs, gaps in existing research and recommendation for future studies. CONCLUSIONS: There is enormous untapped potential for RO-based CVD prevention research, but considerably more work is required to achieve the level of research that is currently conducted in other channels such as worksites and schools. Health practitioners/researchers and ROs are increasingly seizing the opportunity for partnerships to improve health. The knowledge gained from these projects and their documented successes will hopefully encourage other components of the public health system such as hospitals, managed care organizations and departments of health to continue developing ways of including ROs in health research and behavior change programming.