Intervention IP-076: Faith Moves Mountains: A CBPR Appalachian Wellness & Cancer Prevention Program
Summary
This intervention took place in six counties of rural Appalachian Kentucky where local lay health advisors delivered a 12-week Cooper/Clayton Method to Stop Smoking program, leveraging sociocultural factors (i.e., religious participation). With post-intervention data from 92% of participants, those in intervention group churches had 13.6 times higher odds of reporting quitting smoking one month post-intervention. This intervention has strong potential to reduce smoking rates and improve individuals' health.
Overview
To increase tobacco quit rates through a group-randomized community–based intervention in six Appalachian counties
Research-Tested — Interventions with strong methodological rigor that have demonstrated short-term or long-term positive effects on one or more targeted health outcomes to improve minority health and/or health disparities through quantitative measures; Studies have a control or comparison group and are published in a peer-review journal; No pilot, demonstration or feasibility studies.
Intervention Details
Both Community and Academic/Clinical Researchers
Citations:
-
Schoenberg NE, Bundy HE, Baeker Bispo JA, Studts CR, Shelton BJ, Fields N. A rural Appalachian faith-placed smoking cessation intervention. Journal of religion and health. 2015 Apr;54(2):598-611. PubMed
PubMed Central DOI
Relevance: Main Intervention -
Schoenberg NE, Studts CR, Shelton BJ, Liu M, Clayton R, Bispo JB, Fields N, Dignan M, Cooper T. A randomized controlled trial of a faith-placed, lay health advisor delivered smoking cessation intervention for rural residents. Preventive medicine reports. 2016 Apr 2;3:317-23. doi: 10.1016/j.pmedr.2016.03.006. eCollection 2016 Jun. PubMed PubMed Central DOI
Relevance: Post-Intervention Outcomes, Evaluations and Assessments
Yes
The Cooper Clayton Method to Stop Smoking
Richard Clayton, Professor Emeritus, University of Kentucky College of Public Health Department of Health Behavior and Society, clayton@uky.edu
Not available
Citations:
-
Clayton, R., Cooper T, (2004) The Cooper/Clayton Method to Stop Smoking, Institute for Comprehensive Behavioral Smoking Cessation. Link
Yes
Contact Information
Nancy Schoenberg
Department of Behavioral Science, University of Kentucky, Lexington, KY 40536-0086
None
nesch@uky.edu
859-323-8175
Results
Improve minority health or the health of other populations with health disparities (e.g. rural populations, populations with low SES)
Self-reported smoking status
Fagerström nicotine dependence, self-efficacy, and decisional balance
With post-intervention data from 92% of participants, those in intervention group churches (N = 383) had 13.6 times higher odds of reporting quitting smoking one month post-intervention than participants in attention control group churches (N = 154, p b 0.0001). In addition, although only 3.2% of attention control group participants reported quitting during the control period, 15.4% of attention control participants reported quitting smoking after receiving the intervention. A significant dose effect of the 12-session Cooper/Clayton Method was detected: for each additional session completed, the odds of quitting smoking increased by 26%.
Intervention efficacy comparing the proportion of smokers at post-test 1 between intervention and attention control group churches were examined using individual level marginal modeling with generalized estimating equations (GEEs).
Yes
Evaluations and Assessments
No
Demographic and Implementation Description
Cancer/Malignant Neoplasms, Cardiovascular Diseases, Cerebrovascular Diseases, Addiction, Substance Use/Abuse
Unspecified
People with Lower Socioeconomic Status (SES), Underserved Rural Communities
Young Adults (18 - 39 years), Middle-Aged Adults (40 - 64 years), Older Adults (65+ years)
Socio-demographics / Population Characteristics
Rural
People with Low Education
Kentucky
Low SES
Minority Health and Health Disparities Research Framework
| Levels of Influence | |||||
|---|---|---|---|---|---|
| Individual | Interpersonal | Community | Societal | ||
| Determinant Types | Biological | ✔ | |||
| Behavioral | ✔ | ✔ | ✔ | ✔ | |
| Physical / Built Environment | ✔ | ✔ | ✔ | ✔ | |
| Sociocultural Environment | ✔ | ✔ | ✔ | ||
| Health Care System | |||||
Community Involvement
The community's role in different areas of the Intervention (Choices are "No Role", "Participation", and "Leadership"):
Leadership
Leadership
Participation
Leadership
Leadership
Leadership
Leadership
Participation
Characteristics and Implementation
Behavior Change
Primary Prevention
Local Community (e.g. Barbershops, Beauty / Hair Salon, Laundromats, Food Markets, Community Centers), Houses of Worship
In-person
Community Health Worker/Promoters
Conceptual Framework
Social Cognitive / Social Learning Theory, Social Identity Theory, Social Support / Social Network Theory, Social Systems Theory
Social Determinants of Health Conceptual Framework, Social Ecological Model
Implementation
Cluster Randomized Controlled Trial
590
585
2009
2013
Intervention Exposures
7-9 months
Every Three Months
More than 10 Sessions
1-2 Hours
Group (e.g. Community leaders)
Grade 8-9
Adaptations and Modifications
| Intervention Elements | Modified |
|---|---|
| Content |
No |
| Context |
Yes |
| Implementation |
Yes |
| Funding |
No |
| Organization |
Yes |
| Participants |
No |
| Providers |
Yes |
| Sociopolitical |
No |
| Stages of Occurrence | Yes |
Modification Details
| Explanation | |
|---|---|
| Context | |
|
Personnel, Population, Setting |
The intervention delivery personnel were modified from professionals to lay health advisors. The population changed from patients to all people, specifically church goers. The setting changed from public health departments to community settings, particularly churches. |
| Implementation | |
|
Delivery |
The delivery was modified to include additional social activities rather than holding the sessions and having everyone leave immediately thereafter. We added a social hour. |
| Organization | |
|
Availability of Staffing / Technology / Space, Culture / Climate / Leadership Support, Location |
We modified the staffing to use well trained and certified lay health advisors rather than public health professionals. The space and location was modified to “go to where the people/potential participants were” – community settings rather than the public health clinic and the climate was altered to focus on social interactions rather than only educational/behavior change. Participants suggested this change because quitting smoking is hard enough—doing it alone or without a lot of social support seemed overwhelming. |
| Providers | |
|
None |
Our providers, all lay health advisors rather than professionals, focused on working with underserved rural residents and understanding their unique circumstances rather than considering the behavior or the program only; social context was a consideration. |
| Stages of Occurrence | |
|
Implementation, Planning/Pre-implementation/Pilot |
The intervention was modified prior and during the intervention to reflect local circumstances. |
Impact, Lessons, Components
Yes
Some of the settings (churches, community settings) began to offer more health programming. Also, many of our lay health advisors took on additional positions and their capacities grew so they could engage in other employment opportunities.
Researchers need to be present in the community often and offer a non-judgmental environment; provide a needed service where people live
Some of the settings (churches, community settings) began to offer more health programming. Also, many of our lay health advisors took on additional positions and their capacities grew so they could engage in other employment opportunities.
Lessons Learned
We learned the importance of starting a behavioral chance intervention when (and only when) participants are ready without assuming that an environment is not conducive to hosting an intervention. We learned the importance of trusted local people.
Insights Gained During Implementation
| Insight Category | Insight Description |
|---|---|
| Logistics | It takes a while to embed an intervention in an unconventional setting; there is variation in these settings (some with meeting space). The community leader must be on board and advocate for your program and it's best if they also participate in the program. |
| Equipment / Technologies | At the time, rural connectivity to internet and cell phone was minimal and could never be relied on. The same is often true 10 years later. |
| Training / Technical Assistance | Training had to be modified to accommodate interventionists who had never worked in health, but were viewed very favorably. Human subjects protection training was essential to ensure confidentiality and privacy concerns were honored. |
| Recruitment | We had to be patient and accept low initial enrollment. We waited about a year before we were invited to do our intervention in the churches. Once one small rural church hears about a program others want to be included, so rolling and snowballing recruitment was possible. |
Intervention Components
No
N/A
Products, Materials, and Funding
| Used for Implementation | Needed for Sustainability | |
|---|---|---|
| Expertise | ||
|
Community mobilization, community organization/coalition building |
Yes | Yes |
| Partnerships | ||
|
Community groups (e.g. faith-based organizations, barbershops, beauty-salons, laundromats, food markets, community centers, cultural associations, tribal groups) |
Yes | Yes |
| Funding Sources | ||
|
Public funding (e.g., federal, state or local government) |
Yes | No |
Product/Material/Tools
Implementation Materials and Products
| Material | |
|---|---|
| Implementation/Delivery Materials | |
|
Coordinator or Facilitator’s Guides |
https://www.kcp.uky.edu/community/tobacco/cooperclayton/toolkit/Toolkit%20updated%20July%202013.pdf
|
|
Coordinator or Facilitator’s Guides |
https://ebccp.cancercontrol.cancer.gov/uploads/RTIPS/-=RT=-/WHE/DoHHS/NIH/NCI/DCCPS/7504.pdf;jsessionid=4EC02D1AD150EB153C10192530E415B5
|
|
Curricula |
https://www.kcp.uky.edu/community/tobacco/cooperclayton/toolkit/Weekly%20Classes/Intro%20Week/Curriculum_Introduction%20Week%20updated%205-2013.pdf
|
| Implementation/Output Materials | |
| No Implementation/Output Materials provided. | |
Articles Related to Submitted Intervention
| Article | |
|---|---|
| Reports/Monographs | |
| No Reports/Monographs provided. | |
| Additional Articles | |
|
Evaluation |
Attachment available for request at the bottom of the page. |
|
Quantitative findings |
Attachment available for request at the bottom of the page. |
|
Qualitative findings |
Attachment available for request at the bottom of the page. |
|
Methodology |
Attachment available for request at the bottom of the page. |
Materials Available for Request
- Outreach_recruitment tools Updated recruitment flyer with picture.pdf
- Author_manuscript 2015 Schoenberg Rural Appalachian Faith-Placed Smoking Cessation Intervention.pdf
- Author_manuscript 2016 Schoenberg Randomized controlled trial- faith-placed, lay health advisor delivered smoking cessation intervention, rural residents (1).pdf
- Author_manuscript Kruger 2012 Perceptions of Smoking Cessation Programs in rural App.pdf
- Author_manuscript Rural Religious Leaders’ Perspectives on their Communities’ Health Priorities and Health.pdf