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Over the last three decades, there has been increasing interest in the role that faith-based organizations (FBOs) can play in promoting health and health care access among underserved populations. Although the research literature on church-based health interventions is growing, there are relatively few rigorous evaluations of their effectiveness in addressing health and health care outcomes. Establishing a national faith-based health research network is an excellent opportunity to create an evaluative infrastructure and generate new research on health programs and their effectiveness in FBO settings.
Research suggests that faith-based organizations (FBOs) can promote health and well being both within congregations and throughout communities.1–3 This evidence has sparked renewed thinking about whether and how FBOs might best help improve health and promote health equity. Appropriating federal dollars to FBOs for health-related interventions is one responsive approach; however, such support is the subject of significant controversy.
Over the last decade, the concept of federal support for FBO initiatives has come under increased scrutiny—largely because of the criticism that federal grants for FBOs were more for political expediency rather than to support so-called armies of compassion. Fueling this sentiment have been debates over funding as a potential violation of the boundary between church and state and whether FBOs are more effective than government and non-FBO agencies in providing social services. Moreover, the relationship between faith and health (perhaps, demonstrated through the effectiveness of services provided) is still unknown. Yet, despite a plethora of differing opinions, the strengths of FBOs are many.
Faith-based organizations, defined in this article as places of worship or congregations, represent not only physical safe spaces but also extensive reach into neighborhoods through complex social networks. Through connections with other community institutions, FBOs provide organized access to resources, such as trust, food, health care, informal support, and educational and job opportunities. The National Congregations Study (2006–2007) found that 45% of congregations were involved in formal delivery of social services, while another 27% were involved informally.4 Notwithstanding the potential benefits of congregation-based social service programs and the growing interest in their role as health promotion vehicles, some have argued that stronger evaluative mechanisms that accurately measure health outcomes are necessary to determine effectiveness.3,5
Of course, few FBOs have as their primary goal generating new knowledge regarding health and health care promotion, although such a goal is not inconsistent with many congregations’ social missions. While we are not advocating that congregations, as a whole, become experts in health promotion or health services research, we believe that because they often have access to and trusting relationships with populations often not easily reached by formal health care and public health systems, they could become important research partners in the mission to improve health and health care.
An example of the potential of such a partnership is found in the Carolina-Shaw Partnership for the Elimination of Health Disparities. This partnership, established with funding from the National Institutes of Health National Center on Minority Health and Health Disparities, is a collaborative involving a diverse group of theological educators and public health professionals and researchers from Shaw University and the University of North Carolina at Chapel Hill and 25 predominantly African-American churches in North Carolina.6 Through extensive relationship-building within and across organizations, committed leadership and support, new information on processes leading to interventions that target health outcomes has emerged.6 There is also evidence that faith leaders and their constituents are enthusiastic about working with the science community to address health and health care.7 Currently, the partnership has a database of over 3,400 congregations and offers great potential in disseminating information about health and health care. However, this potential remains limited to a particular region and race-ethnic group, while FBOs are common in many communities and ethnicities across the U.S.
A model for operationalizing more broadly FBOs’ potential roles as research partners in the pursuit of health may be found in the burgeoning landscape of national health-related research networks. One of the first health-related research networks to be established, the Primary Care Practice-Based Research Networks (PBRNs), relies on community-based clinicians to investigate clinical and organizational questions central to primary health care, resulting in evidenced-based recommendations that advance quality primary care through scientific research.8 Advantages of these networks include access to a diverse array of practitioners and populations served, the ability to address a variety of health care concerns and, provision of evidence from real-world practice and experience.8 Practitioners are invited to join the network, not only to gain insight and support from colleagues across the country, but also to conduct rigorous research that will inform policy and practice. Within the network, individual clinic practices benefit from tool kits that ensure integrity in the research process or can collaborate with other practices in the network for large-scale studies. Entities such as the Agency for Health care Research and Quality serve as a national resource center to PBRNs, providing network and technical assistance, funding and educational opportunities for network participants. Because of their latitude, health-care networks have become important vehicles for advancing new knowledge in health care. As the Institute of Medicine proclaimed, together they are “the most promising infrastructure development that [the committee] could find to support better science in primary care.”9 [p. 231]
A similar type of research network could be developed to connect FBOs engaged in or interested in health-related research. Individual FBOs may serve relatively small populations but together reach large numbers of people. A national FBO research network could serve as a platform for developing and evaluating community-based approaches that improve health outcomes and eliminate disparities. There are few structures that link the various FBOs working in health and enable them to exchange ideas or combine data or experience on health promotion efforts, thus a national faith-based health research network could provide such a structure. What would be the goals of such a network, what would it look like, and what support would the network need to ensure its sustainability?
The goals of a national faith-based health research network would be three-fold:
Increasing FBO capacity to conduct or participate in evaluative research is a necessary objective in promoting an evidence-based approach to health interventions in FBO settings. In the U.S., where the median size of a congregation is approximately 75 members,4 there is likely limited capacity to perform on-going evaluations of the services provided. A network would offer opportunities for hands-on training and support from partners experienced in research. These partnerships would be the foundation on which FBOs could build the capacity to inform health promotion and service delivery effectively.
Contributing new knowledge regarding best practices for health promotion and healthcare delivery within the context of FBOs would result from the evidence-based approach. Such knowledge would enhance our understanding of health and health care in populations underserved by the health care system. A unique population to engage at this juncture would be faith leaders (clergy and lay) who are also trained health professionals and researchers. Though the exact numbers of this population are not known, they do exist (two of us fall in that category, CA and KD) and would be important assets in building bridges between the science community and FBOs. The creation of a national faith-based health research network may aid in identifying these distinctly qualified faith-leaders. Moreover, such expertise could facilitate the development of more accurate outcome measures that not only assess program effectiveness but also capture the possible interaction between faith and health.
After research assessing the effectiveness of interventions in faith-based settings is produced, dissemination of these findings would follow. In this network, FBOs’ abilities to facilitate the flow of information about community problems and resources10 would enable the dissemination of evidence-based information both within and beyond the research network. Products may include best practices and tool kits for health care providers and FBOs that want to work in partnership. A robust network would allow community organizations access to programs and methodologies that can improve their ability to deliver social services, including those specific to health. Mobilizing FBOs and promoting dissemination efforts may be a critical vehicle for creating social-norm change related to health.11
Our proposed national FBO-health research network would benefit from the diverse range of FBO organizations in the country. FBOs joining the network would meet certain criteria, demonstrating organizational will and capacity to address public health issues. A regional focus, with partners from academic and research organizations, schools of theology, denominations, and other groupings of FBOs, would facilitate effective network operations during its infancy. Within these regions, organizations that are able to leverage funding to create capacity-building academies to assist FBOs can be identified. The question becomes, “What incentive would the average FBO have to join such a network?” Certainly, FBOs that desire to promote a health message would receive the greatest benefit from the network—which include access to health information, best-practices tool kits and potential collaborations yielding greater leveraging power for funding. Equally important would be the supportive connection to individuals and FBOs that are involved in similar efforts—much in the same way that clinicians have benefitted from PBRNs.
Nevertheless, the notion of a faith-based health research network does present some conflict and potential challenges. For instance, while PBRNs are often linked to a professional organization or academic body (ensuring integrity), identifying an analogous coordinating body of a faith-based health network may prove difficult. PBRNs tend to use standardized processes and protocols and such an approach may not easily translate across the heterogeneous faith community. Conflicts between faith-based belief systems and practices and public health approaches could also impede support and progress (e.g., disagreements regarding sexuality and reproductive health concerns). Alternative pressures may include a shortage of funding from academic and government agencies ultimately compromising sustainability; conflicts between FBOs and researchers in partnership; lack of effective recruiting mechanisms; and, the departure of so-called network champions within FBOs due to the high turnover of volunteer support in FBOs. All have the potential to weaken the network. As a result, some key questions require consideration. Does such an entity exist for FBOs and congregations desiring to have an anchor from which to investigate and disseminate useful information? Could the network, itself, serve as that anchor? How would recruitment and retention be addressed? Many of these challenges will require investments—a thorough investigation of best practices on establishing a research-focused network (including government), raising support from FBOs and non-FBO organizations and agencies, and planning grants to facilitate the implementation of faith-based health research networks.
Essential to the longevity and success of a national faith-based health research network is financial support. Such funding will have a different intent than what had been emphasized in the previous Faith-Based and Community Initiative (FBCI), initiated in 2001 to encourage greater participation by faith-based and community-based organizations in federally-funded human service programming. It is important to note that despite the substantial growth in federal funding available to FBOs, there has been no increase in the proportion of congregations involved in social services, in receipt of public funds for their social service work, or in collaborations with the government.4 The intent of funding for a national faith-based health research network would be to involve FBOs in the shaping of research, programming, and (ultimately) policy related to health and health care. Funding would assist the network in developing and tracking appropriate health and health care outcomes that could inform future faith-based strategies aiming to improve health. That is, it could help establish how and under what conditions FBOs can best promote health and reduce health disparities while clearly emphasizing measurable outcomes, as opposed to process measures such as numbers served. This information may also be helpful to the current White House office (the White House Office of Faith-Based and Neighborhood Partnerships), which has made health outcomes one of its top priorities.
A national faith-based health research network is an excellent opportunity to create an evaluative mechanism and generate new research on health programs and their effectiveness in FBO settings. Precedent already exists for federal funding of similar initiatives through the Health Resources and Services Administration (HRSA), the Agency for Healthcare Research and Quality (AHRQ), and the National Institutes of Health (NIH).12 The network has the potential to produce program evaluation instruments and emphasize present pathways for the accelerated dissemination of information. With a robust network, the question of effectiveness could be answered and the ability to tease out the effects of health interventions in FBOs versus religiosity effects on health outcomes would be enhanced.13 Moreover, development of a national faith-based health research network could be responsive to the Obama administration’s dual interests in science and support for community-level faith-based initiatives.
Faith-based organizations are potential partners in facilitating advances in health outcomes. Existing PBRNs can serve as an applicable model for how to organize FBO assets for health in a coordinated and sustainable fashion. The benefits to the science and faith communities, and communities at-large, would be substantial: the creation of synergistic modes of combating health disparities; increased capacity of FBOs to develop and implement effective interventions through the network; the ability to measure effectiveness; and the capacity to disseminate new information to underserved populations. There is no doubt that establishing the network will take time, institutional and financial resources and a commitment from researchers, FBOs, government, and society alike to see it succeed. But once embarked upon, the potential quality of evidence obtained through the shared efforts of a reputable national faith-based health research network will assist us in meeting the health care challenges of this century.
Authors’ Financial Disclosures: Dr. Asomugha’s contribution was supported by a grant from the Robert Wood Johnson Foundation Clinical Scholars Program. Dr. Derose’s contribution was supported in part by grant number 1R01HD050150 (Derose) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The commentary’s contents are solely the responsibility of the authors and do not necessarily represent the official views of NICHD or the Robert Wood Johnson Foundation Clinical Scholars Program.