the health disparities podcast

192: How might religion benefit cardiovascular health among Black Americans?

Participating in religious activities appears to benefit cardiovascular health among Black Americans. It’s something we explored in an episode on this podcast a few years back.

Health systems, professional societies and researchers are increasingly recognizing that “faith-based organizations are trusted institutions within underserved communities and that people not only seek spiritual refuge and salvation in these places of worship, but they are also wonderful, trusted vessels to  distribute reliable health information,” says Dr. LaPrincess Brewer, a faculty member in the division of  Preventive Cardiology, department of Cardiovascular Medicine at Mayo Clinic.

“Participating in religious activities from church services to private prayer, as well as holding deep spiritual beliefs are  linked to better cardiovascular health among Black Americans,” according to researchers of a 2022 study published in the Journal of the American Heart Association.

The researchers go on to suggest that recognition by health professionals and researchers of the centrality and influence of religiosity and spirituality in the lives of African American adults may serve as a means to address cardiovascular health disparities.

In an episode that was first published in 2023, Movement Is Life’s Dr. Mary O’Connor spoke with Dr. Brewer, whose primary research focus is reducing cardiovascular disease health disparities in racial and ethnic minority populations  and in underserved communities; and Clarence Jones, a community engagement specialist and former director of community engagement at a federally qualified health center in Minneapolis who has extensive experience in  collaborating with community and faith-based partners in promoting community wellness and access to health services.

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The transcript from today’s episode has been lightly edited for clarity.

Dr. LaPrincess Brewer: They’re recognizing that, you know, faith-based organizations are, you know, trusted institutions within underserved communities,  and that people not only seek, you know, spiritual refuge and salvation, you  know, in these places of worship, but they are also wonderful, trusted vessels to  distribute reliable health information, right? So, this is how the American Heart  Association and other professional, you know, societies have partnered with  these organizations including, you know, health professionals such as, you know,  us and you know, researchers and also broader health systems have also  partnered with churches. So, you know, I’m really pleased to see that we’re now  moving towards integrating, you know, this key influence on health into programming.

Jerail Fennell: You’re listening to the Health Disparities Podcast from Movement is Life – featuring conversations about health disparities with people who are working to eliminate them. I’m producer Jerry Fennell.

Research supports the notion that participating in religious activities can benefit cardiovascular health among Black Americans.

It’s something we explored in an episode on this podcast a few years back — with Mr. Robert “Clarence” Jones and Dr. LaPrincess Brewer. And we’re taking some time today to revisit that conversation.

Clarence Jones is a community engagement specialist and former  director of community engagement at a federally qualified health center in  Minneapolis. He has extensive experience in  collaborating with community and faith-based partners in promoting community  wellness and access to health services.

And Dr. LaPrincess Brewer is a faculty member in the division of  Preventive Cardiology, department of Cardiovascular Medicine at Mayo Clinic in  Rochester, Minnesota. Dr. Brewer’s primary research focus is reducing cardiovascular disease health disparities in racial and ethnic minority populations  and in underserved communities.

They spoke with Movement Is Life’s Dr. Mary O’Connor for an episode in 2023.

Dr. O’Connor: You are listening to the Health Disparities Podcast, a program of Movement Is  Life. Movement Is Life is a philanthropic, multidisciplinary coalition founded in  2010. We seek to decrease musculoskeletal health disparities among women,  racial and ethnic minorities, and people living in rural communities. As a nonprofit  organization, we focus on raising awareness of the impact of disparities on  chronic disease management and quality of life through programs that focus on  early intervention, education, behavior change, and advocacy. I’m Dr. Mary  O’Connor, chair of Movement Is Life and your host for today. I’m also the co founder and chief medical officer of Vori Health and Professor Emerita of  Orthopedics at Mayo Clinic and past professor of Orthopedics and Rehabilitation  at Yale School of Medicine.

Research findings published in the Journal of the American Heart Association  towards the end of 2022, found that, “Participating in religious activities from church services to private prayer, as well as holding deep spiritual beliefs are  linked to better cardiovascular health among Black Americans.” The researchers  go on to suggest that recognition by health professionals and researchers of the  centrality and influence of religiosity and spirituality in the lives of African  American adults may serve as a means to address cardiovascular health  disparities through sociocultural understanding and the strategic development of  culturally relevant lifestyle interventions, unquote. We will put a link to the paper  in the program summary. So, we know that musculoskeletal health disparities go  hand in hand with cardiovascular health disparities. So, I am so excited to have  with us today to discuss these research findings and some of their implications, Mr. Robert “Clarence” Jones and Dr. LaPrincess Brewer. Mr. Clarence Jones,  M.Ed., CPH, CHW, CPE is a community engagement specialist and former  director of community engagement at a federally qualified health center in  Minneapolis. He served as a member of the Clinical and Translational Science  Institute Executive Leadership team and the Public Health Disparities Research  Board at the University of Minnesota. Mr. Jones has extensive experience in  collaborating with community and faith-based partners in promoting community  wellness and access to health services. Welcome Mr. Jones.

Clarence Jones: Dr. O’Connor, thank you for the invitation to be a part of this show today.

Dr. O’Connor: Thank you. Our second guest is Dr. LaPrincess Brewer, who also has a Master’s  in public health, and she is an assistant professor of medicine in the division of  Preventive Cardiology, department of Cardiovascular Medicine at Mayo Clinic in  Rochester, Minnesota. Dr. Brewer’s primary research focus is reducing 

cardiovascular disease health disparities in racial and ethnic minority populations  and in underserved communities. She has a special interest in increasing  minority and women’s participation in cardiovascular clinical trials through mobile  health interventions. Welcome Dr. Brewer.

Dr. LaPrincess Brewer: Thank you so much for having me today.

 

Dr. O’Connor: Okay. So, we have two incredible experts to talk about this exciting study. Dr.  Brewer, I’m going to start with you. We know that African American adults have a  higher prevalence of cardiovascular risk factors. This leads to higher cardiovascular disease mortality than white adults. So basically, it’s more likely  for an African American to die of heart disease than a white American. The years  of life lost are really pretty staggering and a major factor in the life expectancy  disparities that we see between African American and white populations, and  also between low income and high-income populations. And it’s a pattern that’s  repeated right across the nation. So, Dr. Brewer, please share with us what  you’re seeking to understand with your disparities research.

Dr. LaPrincess Brewer: Sure. Yes. So, my research seeks to better understand the root  causes of cardiovascular health disparities. And as you can imagine, these are  very complex but are significantly influenced by what are called the social  determinants or drivers of health and these are environments in which people are  born, live, work, play, and worship, which is relevant to our study that affect  health outcomes. And they can either be negative or positive influences on heart  health. Unfortunately, African Americans are faced with an overwhelmingly high  burden of negative social determinants of health, including chronic stress. And these can be related to factors such as food insecurity, systemic racism, the  wealth gap, and socioeconomically disenfranchised communities. And many of  these issues have been amplified or magnified even during the COVID-19  pandemic. And these challenges prevent African Americans from living their best  lives by following a healthy lifestyle to prevent heart disease in the first place and  they hinder their ability to control their heart disease risk factors. So, my  research, and, you know, this particular study, you know, focuses on better  understanding psychosocial influences on health behavior change among African Americans. These include factors like diet and physical activity, self-regulation,  how you’re able to do this on your own and your confidence to do so, as well as  social support. And social support comes from in our study, you know, the faith  community or the black church. And we integrate these into community-based  behavioral interventions that, as you mentioned earlier, are culturally tailored for  African Americans to assist them in better adopting and actually maintaining, you  know, healthy lifestyles. So, I’m the founding director and principal investigator of  the Faith Cardiovascular Health and Wellness Program. And every great  cardiologist or clinical investigator has to have an acronym, right? So, faith  stands for Fostering African American Improvement in Total Health. And more  recently we’ve studied in this particular article, the role of religiosity and  spirituality in cardiovascular health. And we found that those reporting higher  religiosity and spirituality were more likely to reach recommended guidelines for  physical activity, diet, smoking, and blood pressure. And our findings truly  highlight the importance and value of faith-based interventions, including  churches for prevention and control of heart disease.

Dr. O’Connor: Wow. First of all, that’s so important, such an important finding that I think people  may have linked or intuited, but that doesn’t, as we know, that doesn’t cut it in  medicine, right? You need peer reviewed research to say, okay, we think this is  important, this link between patients having the social support that is spiritual in  nature, that is somehow linked to spirituality and their overall health and  wellness, and the behaviors that they adopt or shed, right, that there is a clear  link. Mr. Jones, I would love you to comment on this.

Clarence Jones: I think it has been a, a wonderful, wonderful experience of working with  Dr. Brewer. Let me tell you a little bit about myself and kind of weave this  together. I am called the Community Health Strategist for the Hue-MAN Partnership. And so, my job is to find the treasures in our community that can  help us to be able to address the issues around health. And so, I spend a lot of  my time talking to people, probing people. I’m a prober asking a lot of questions  but our whole goal is to strengthen community health through innovative  partnerships. It is so important for us to find the right, I want to use this term  spearhead in a very positive manner to really find the right people to lead the  charge because in so many times in our communities, there has been such a  matter of distrust with the health profession, and we’re trying to figure out what  are the ways in which we might be able to positively engage the community with  innovation, but also strengthen them through, you know, transparency through  honesty, and then giving them the appropriate information for them to make an  informed decision. And so, part of our work is to find those treasures, those organizations that may not be getting the press or may not be getting the  notoriety that other people get. And so, we have the opportunity to work with  HMOs. We have worked with federally qualified health centers and neighborhood organizations. We work with the academic community with a lot of universities,  work with researchers. We work with nonprofits, and we also work with you  know, just individuals who have self-identified. And that’s another important thing  for me in terms of this work is who have self-identified that they want to work with  us. I always tell this story. I hope it’s okay, Dr. Brewer, when I tell this particular  story because of the way I said this a little bit earlier, we are looking for the  treasures in the community. When I met Dr. Brewer, when I was introduced to Dr.  Brewer, it took us 18 months to vet her.

 

Dr. O’Connor: Wow. Dr. Brewer, I didn’t know you had such a complicated past! Dr. LaPrincess Brewer: The interrogation room!

Clarence Jones: Well, she was from Mayo, you know, and so, you know, so, you have that  history, and you have that perception, you have those myths, those kinds of  things. And so, she was coming to our community and what we wanted to do was  say, well, we like what you’re saying, but we have to figure it out and to learn and  to know you before we are able to, you know, to present you to our community.  You know that, for a lot of people might be a lot, but for us, it was important  because we had communities that had been struggling for such a long period of  time, and we really wanted to find the treasures. And so, Dr. Brewer has really become a treasure for us in terms of this work because she’s authentic. And we  wanted to make sure that we were promoting the people that were really going to  make a difference and going to move the needle for us in terms of health.

Dr. LaPrincess Brewer: Oh, thank you so much for those kind of words, Clarence. But yes,  I feel as if I learned more from the community and the faith community, you  know, than I’ve probably given back to them. But yes, I really appreciate all that,  you know, I’ve learned, and everything happens for a reason. So, you know,  having that time for trust and relationship building has actually brought us to  where we are today, right. Doing a podcast with you today discussing research  that is going to be shared with a broader audience. So, you know, we don’t take  this lightly, so we really appreciate you having us.

Dr. O’Connor: I’d like to explore a little bit more, Dr. Brewer, some of those learnings, like you  just commented, you learned more from the community than you got, more than  what you think you gave. So, what are some of those gifts that you received?

Dr. LaPrincess Brewer: Yes, so I’ve learned from the community throughout this process  that sometimes you have to release your own agenda and let the community  guide the agenda. That’s something that, you know, we as health professionals  and researchers and leaders of research have the hard, difficult, you know, time  with, because we’re used to, you know, setting, you know, what the research  question is and, you know, how are we going to disseminate this back, you know,  to the community, you know, on our own terms. But I had to really show my own  cultural humility, if you will, and listen to the community. That’s the biggest lesson  that I’ve learned, is that you have to listen. And when you listen to the  community, you’ll see how much wealth of information that the community has  that can enrich your own research program. And I’m sure we’ll get into it, but, you  know, my research initially started as, you know, in-person seminars going out  into the community, but the community said, hey, we got to, you need to move with the times, Dr. Brewer. Let’s move digital, you know, with mobile health and  digital health. And, you know, if I wouldn’t have listened, you know, I wouldn’t  have been able to innovate and transform my research into what it is today. So, I  would say those are some of the things that I gathered. You really have to, one,  release your own agenda and, you know, really listen to the community and what  they identify as priorities versus what you may identify. You may meet in the  middle, but I think it does take some time to listen for that trust and relationship  building.

Clarence Jones: When Dr. Brewer came to us and she was talking about what she wanted  to do one of the things I told her was, this isn’t Baltimore. And what I meant by  that was that we are talking about, there are things that you learned, this is, there  are different things and different factors here that you may have learned there  that may not be as effective here. And she heard us. But there are things that  when you come into a new space, you have to be willing and open in order to be  able to be more effective. You know? And if you’re not willing to do that, then  you’re going to miss the type of growth, though, the type of experiences or the  type of learning that you can do. So that’s another part of our story.

Dr. LaPrincess Brewer: And what Clarence is referring to is, I did my training, clinical  training at Johns Hopkins in Baltimore, Maryland and that is where my faith  program was actually founded. So, when I moved to Minnesota, I wanted to  translate that here to Minnesota. But as Clarence mentioned, he said, oh, well,  you know, this isn’t Baltimore, this is Rochester and Minneapolis, St. Paul, you  know, Minnesota. So, you need to, you know, check your audience.

Dr. O’Connor: But I think that what you, what you’re speaking about, is basically a fundamental  issue that we have throughout medicine. For example, in my company, Vori  Health, you know, we have really focused on identifying what matters to patients,  not just what is the matter with them, what matters to you, right? If you have knee  pain, why does that matter? Because you actually want to run a 5k, so, or you  want to be able to play with your grandchildren if you have back pain, right? So, we’re focused on how do we help you achieve that goal that matters to you. Okay, we need to address your knee pain or your back pain but again, it’s flipping  the script to say it’s what matters to you, what matters to your community, to this  community, right could be far different than what matters to another community.  And then staying focused on that to help address that. So, it really is a different  mindset in medicine, right, where we’re so used to a kind of doctor driven,  paternalistic approach. And it’s not that, you know, it’s not that the physicians  don’t have the, they do, they have the knowledge, right but it needs to be team, it needs to be a team-based approach. 

Dr. LaPrincess Brewer: Yes. 

Dr. O’Connor: And the goal has to be the goal that’s focused on the needs of the community.

Clarence Jones: Dr. O’Connor, I’d like to say this real quick. I think that you’re absolutely  correct. And one of the other things that was important with the work that we’ve  done is that we look at the assets of the community. 

Dr. O’Connor: Oh, yes.

Clarence Jones: We don’t come in there with the whole idea about deficits. Oh, there’s  something so wrong with you. Like you just said, you know, what are you looking  for? What’s going well and how do we improve that, how do we enhance that?  And if you can do that, I mean, Dr. Brewer has been extremely good at that,  listening to what we’re saying, because people are already beaten down. I mean,  you know, people are already having issues, and we’re trying to move them to a  different level as it relates to health disparities in our various communities, and  the only way that you can do that is by making sure that people understand that  they’re valued.

Dr. O’Connor: I think this linkage that you found, which to me is so intuitive, but nonetheless,  right, that spirituality impacts health like, that’s like a duh for me personally, but  obviously not necessarily for everyone. So, Dr. Brewer, the research has focused  on the American Heart Association, essential eight healthy behaviors as basically  key measurable parameters because you know, in medicine we have to measure  things. Right. So, can you tell us a little bit more about these Essential Eight  indicators and why you found them to be a good fit for your research?

Dr. LaPrincess Brewer: So, the Life’s Essential Eight are an update from the prior version  of the American Heart Association’s Life’s Simple Seven. And they are vital  measures for improving and maintaining cardiovascular heart health. And they  include stopping smoking or vaping, eating better, healthy eating maintaining an  act of lifestyle, losing weight or maintaining a healthy weight, managing your  blood pressure, controlling your cholesterol, and reducing or controlling your  blood sugar. And the final one, that was the addition to the Life’s Simple Seven to  Life’s Essential Eight, was adding sleep, which I love, which we all love, right?  And these are, you know, all things that we can do to reduce our risk for heart  disease and to live longer, stronger, and healthier lives. And the reason why we  integrated this into our research is because it really encompasses lifestyle  change. So, it has both, you know, health behaviors and, you know, clinical and  biological, you know, factors but each person, you know, is doing better or worse  than each of these. We all have our things that we can work on, you know, and  our community really liked having this entree, if you will, of things that they could  work on to improve their overall cardiovascular health versus just telling them  what to focus on. So, it gave them more autonomy and control, you know, over  healthy lifestyle change. And we’ve used this in several of our studies as our  primary or the main outcome which has shown improvements in overall heart  health. With that update, you know, from the Life’s Simple Seven to the Life’s  Essential Eight, I was honored to serve on the writing group with the American  Heart Association President, Dr. Donald Lloyd Jones as past president and  cardiovascular epidemiologists and cardiologists along with other national  leaders. And, you know, we really put our heads together in putting together the  Life’s Essential Eight and updating it so that it’s more user-friendly, and that it  also has a focus on psychological health and wellbeing. And I was honored to  write that section, you know, within the paper on psychological health and  wellbeing and cultural tailoring of the Life’s Essential Eight to meet the needs of  patients and the population. So, it fits right in and aligns well, you know, with  what we’re doing with this religiosity and spirituality paper, as well as our faith  program.

Dr. O’Connor: Mr. Jones, how helpful do you think this Essential Eight concept is to a  community? So, where they can actually kind of see in, you know, very discrete,  you know, bundles, areas where they could focus their behavior to improve their  health?

Clarence Jones: You know, that’s quite interesting. We had actually did a a survey using  My Strength by Health, which is something from the University of Minnesota that  we’ve been using. But what we found out during that particular survey, we found  out that there were two things that the community was really struggling with, and  it was relationships and sleep. Sleep was so…, it came, it was one of the, it came  to the top that this is one of the reasons why people were struggling. We were  taking, you know taking drugs while we’re, during this period of time because,  you know, if you can’t sleep, what do you do? If you’re in a relationship, you’re in  a house with, you know, 10 people and you’ve got a one-bedroom house, what  do you do? You know, you have got to find a way to do it. So, I think that whole  issue around sleep, and I was so excited when the American Heart Association  had that, because it just confirmed, I mean, even before we knew that, before we  saw the report, it confirmed how important sleep was. And for us as a people to  be able to address.

Dr. O’Connor: Oh, it’s so important. And it is one of my personal behavior improvement goals.  Right? 

Clarence Jones: I get it. I get it. 

Dr. LaPrincess Brewer: Mine too. I work on it every day. 

Dr. O’Connor: More sleep, better quality, sleep.

Clarence Jones: Exactly.

Dr. O’Connor: I mean, it’s so important and we all know it makes a big difference, right? Clarence Jones: Right. 

Dr. O’Connor: You get a nice sleep, everything is better. 

Clarence Jones: Right. 

Dr. O’Connor: And, of course, that is what I tell my children, you know.

Clarence Jones: Yes, yes, exactly. 

Dr. O’Connor: Go to bed. It’ll be better in the morning. Right? 

Clarence Jones: Yes, yes, yes.

Dr. O’Connor: All right, Dr. Brewer, I’m going to, this might be a provocative question. Why does  the Essential Eight, why is the Essential Eight not an essential Nine and spirituality be included as a ninth item?

Dr. LaPrincess Brewer: Yes, so interestingly, we said we could have Life’s Essential 20  plus because once we all got together in this group to write this, we all had our  own, you know, we want you to add this, we want you to add that. And of course,  I was the psychosocial influence person, hey, we have to have stress, we have to have spirituality, religiosity. But it was really difficult to find a way to measure that  appropriately because it’s influenced by so many different aspects, as I mentioned, kind of at the beginning with the social determinants of health. And  there’s no clear measure across the entire population to measure, you know, all  of this. So, in the end we said, why don’t we just say this is ripe for future  research and maybe the next iteration of the cardiovascular health measure will  have some of these measures because there just wasn’t enough data to support.  So, this study actually would provide more data to support that in the next, you  know, iteration. But that’s the reason, we all had our own things, and it was just  really hard to hone in on one. But we all agreed that sleep, you know, was  probably the next best measure.

Dr. O’Connor: So, Mr. Jones, if the Essential Eight was an Essential Nine and spirituality was  included, how do you think that would resonate in your community?

Clarence Jones: Well, I think spirituality is one of the things that people, whether they talk  about it or not, try to exhibit. You know, some people are more overt about it,  right? And some people are much more quiet about it, but even in the conversation, they’ll give mention to God, or they’ll mention or give mention to a  higher power, or they’ll say something of that nature. So, I think it is very much a  part of our community as a, you know, as a conversation or as a belief system.  The other thing too is I think that there are so many different ways in which  people approach this, you know, to get back to Dr. Brewer’s point, there’s so  many ways that different people approach this, that it really becomes a very  personal position and you have to allow people the opportunity to be able to  express themselves in an appropriate manner because there will be, definitely,  there will be some differences of opinions about how you do that but there are  also some very core values that I think that people have as it relates to spirituality  or what they think spirituality is. So, it is to be discussed later.

Dr. O’Connor: I feel like my next question I want to ask you both could be from like 200 years  ago, right? The separation of church and state, as the founding fathers wrote the  documents for this country, because it’s kind of a question about can, how much  of a difference community makes with or without spirituality? Okay. And the  reason why I ask this is because Movement Is Life, we have a program called  Operation Change, which does not have a defined religious component. And in  Operation Change we bring 40 to 50 women together, adult women who have  knee pain and typically other comorbidities, and for the audience, that means like  diabetes, hypertension, overweight obesity. So and they are from underserved  communities. So, we can have a group that’s African American women, a group  of Hispanic Latina women, a group of rural white women, for example. And we do  that so that we can align the education within the program to be more culturally  relevant, right? If we’re going to talk about how to cook healthier meals, those  recipes can be those that are more culturally aligned with the kinds of food that  they normally eat. And, this program runs 18 weeks, it’s three hours a week. So, an hour of education, an hour of some kind of movement, and the third hour for  small group motivational interviewing. And we’ve done numerous programs with really, honestly impressive results. 18% improvement in walking speed over the  span of the program. And this is a remarkable decrease in their sense of  hopelessness, because so many of these women are depressed and all this  without drugs, doctor visits, antidepressant medications. And when we surveyed  our participants and said, what did you like best about the program? I honestly  thought this was my bias coming into that, that it would be the small group  motivational interviewing sessions because that’s really fundamentally what was  different that we added. But what we learned, again, going back to the beginning  of our conversation where it’s listen to your community, right? What we learned is  that the difference was that we created a community for them, and that they  gained the emotional support that they needed from each other to make the  behavioral health change. So, it’s the fact that we created this community that  made the difference. So, my question to you is, do you think that there’s a big  difference between creating a community or creating a community that also has,  you know a spiritual, you know, background or is linked to spirituality in terms of  improving health outcomes?

Clarence Jones: I think it’s literally impossible to bring people together in a group and have  some kind of continuity without spirituality being brought up. And I, again, I talked  about that whole idea about it being overt but somebody’s going to say, I thank  God for something, you know, and, other people think, yes, yes, yes. You know  what I mean? So, to me community, it’s almost inseparable. It’s going to happen  eventually. That’s my experience. That’s what I think, what I believe that it’s  literally impossible to bring a group of people together, even if they’re having a  good time, where somebody’s not going to talk, bring up spirituality, some kind of way that spirituality is going to pop up.

Dr. O’Connor: Let me just comment on that and then Dr. Brewer, I’d like you to comment.  Dr. LaPrincess Brewer: Sure. 

Dr. O’Connor: We didn’t actually ask them about spirituality and whether they felt they brought  that into the community. So that’s an excellent point, because having visited  some of our programs, I can attest from my personal observation that a lot of  these women are very spiritual and honestly, I mean, when you are, when you’re  in a community where, you know, you have lots of things stacked against you  and lots of challenges, and you cannot control these social determinants, you  know, people gain their strength from, you know, from God, from divine mother,  from whatever their spiritual, you know, linkage is. So that’s just my personal  comment. Dr. Brewer?

Dr. LaPrincess Brewer: Yes. I love this question. But yes, I believe that actually both  matter you know, for patients and community and context is most important and I  believe that the common denominator really for both of our programs is as you’re  alluding to the supportive and communal in environment of both, that, as you  said, created this community and relevant to our work, you know, that community  is the faith or a community or the black church and, you know, we’ve just  harnessed, you know, that established community for health promotion. And it’s  really a form of, you know, cultural humility and understanding and meeting  people where they are right in the community. And as Clarence said, it just  naturally, you know, comes together whether you, you know, identify with a particular religious practice or have your own spirituality, you know, you bring that  to the community.

Dr. O’Connor: Well, I think this is just fascinating. And one area that I want to follow up with you  both on after this podcast is ideas on how your research could help groups, like  Movement Is Life, right, incorporate some of your findings into our community based programs so that perhaps our Operation Change program could be even  more effective than it is now. 

Dr. LaPrincess Brewer: I’d love to.

Dr. O’Connor: So, how have other groups been, for example, the American Heart Association in  being receptive to your research findings to basically incorporate the concept of  spirituality into programs? Dr. Brewer, I’ll start with you.

Dr. LaPrincess Brewer: Yes, I’m really pleased that the American Heart Association has,  you know, expanded its focus and is now, you know really placing a priority and  lens on social aspects and influences of health. And they also have a longstanding, you know, relationship with faith-based organizations for health  promotion. But I believe now there’s a focus of how do we integrate this actually  into the programs. And they’re recognizing that, you know, faith-based organizations are, you know, trusted institutions within underserved communities,  and that people not only seek, you know, spiritual refuge and salvation, you  know, in these places of worship, but they are also wonderful, trusted vessels to  distribute reliable health information, right? So, this is how the American Heart  Association and other professional, you know, societies have partnered with  these organizations including, you know, health professionals such as, you know,  us and you know, researchers and also broader health systems have also  partnered with churches. So, you know, I’m really pleased to see that we’re now  moving towards integrating, you know, this key influence on health into programming.

Dr. O’Connor: That’s fantastic. Mr. Jones, any comment on that?

Clarence Jones: Well, the human partnership, we are definitely a public health focus  organization. And so, spirituality in terms of public health is also one of those  things that emerges for us. And so, we are in that space where we listen to what  the community is saying, it becomes bidirectional, and then we find partnerships  to make those things work. One of the reasons why we’ve been excited about Dr.  Brewer’s process is because it is, it’s still public health. It still speaks very clearly  to the needs of the community. And we are excited about being able to, to  confidently recommend faith to other organizations that we come in contact with.  So, it’s that public health lens that we look at, which also is inclusive of the  spirituality and then, we find ways in which we can, I don’t want to say organically, but we just find ways in which we authentically engage people in the  conversation.

Dr. O’Connor: That’s fantastic. You’re currently developing and testing the feasibility and  acceptability of a culturally appropriate risk-based, digital application intervention,  meaning virtual, right. So, on a mobile device targeting several cardiovascular  risk factors among African Americans, and this is a collaboration between both of you. So, could you tell us a little bit more about this exciting project that you’re  working on?

Dr. LaPrincess Brewer: Yes, so as I mentioned earlier, it’s about listening to the  community. So this idea actually was born from the community, you know, and  that they said, hey, let’s move with the time so that we can increase our reach  and access to the broader community and have it in a form that we can reinforce  many of the concepts that you’re trying to teach us about healthy lifestyle. So,  they suggested moving FAITH from, you know, an in-person face-to-face  intervention to a digital or mobile health intervention through use of a smartphone-based app. And I said, okay, if you want it, you’re going to help me  design it. So, we worked together in co-creating and co-designing this in health  intervention with African American community members to better understand  their needs and preferences and the features. So, they gave us, you know, every  input on everything from font size, color, to the actual images and visuals on the  app and I think that that made it a much better enhanced and culturally tailored  intervention that people were eager to use. It was community vetted, if you will.  And so, again, it wasn’t my own idea, but it was born out of the community. And  this was actually before the pandemic hit too, so it was kind of like right on time,  you know, once we were ready to do this clinical trial. And I also wanted to  mention that, you know, Clarence and I are partners in this, and we applied for  significant funding through the National Institutes of Health and the American  Heart Association to fund this clinical trial. And we wrote this together. I received  feedback, you know, with Clarence as well as our, we have a community steering  committee, which is made up of diverse individuals and organizations, you know,  from the Twin Cities area and Rochester, Minnesota, where, you know, the  flagship Mayo is. So, again our patients engage with the app on their own time  but still kind of in the communal environment of, you know, knowing that my  church is a part of this, I believe, you know, made people more engaged and  want to see it through, if you will. And our results were overall positive. We  actually just published them in one of our top cardiology journals, Circulation.  And it showed that our participants had overall improvement in their heart health  scores according, as we mentioned, you know, the Life’s Simple Seven from the  American Heart Association, which will be updated to the Life’s Essential Eight.  And we also had improvements in health behaviors that are extremely difficult to  change, so diet and physical activity. So, we’re very proud to see that our app  resulted in these significant changes and could ultimately prevent heart disease  among, you know, our participants.

And our app is also now being tested in a community health center. So, Clarence  has many connections with, you know, federally qualified health centers. So, we’re now transitioning that to this health center to improve hypertension control  in African Americans. And I think you’ll be interested in this, when we asked the  patients at this clinic, we didn’t come in with the agenda of talking about religiosity and spirituality, but when we asked them to give us feedback, you  know, on the app, we’re basically transitioning the FAITH app with churches to  the clinic. And we said, what are your thoughts on the religious aspects that we  have integrated into this app? Should we remove this since we’re now going from  the community to the clinic? And the participant said, absolutely not. They felt  that the religiosity and spirituality components were a part of black culture, and  whether they were religious or not, they just felt that it represented their community and many of them mentioned that they weren’t religious at all. So yes.  So, it really brought home the point of, you know, why we’re doing this. So, we’re  now working to optimize the app to allow for broader access to the African  American community at large.

Clarence Jones: So, you’ve just experienced why the community loves Dr. Brewer. She  has mentioned my name about four times, she’ll mention the community members, you know, the same thing. I mean, it’s you know, it’s authentic and  that’s what’s important in terms of making this process, you know, very, very  effective. But the app is something that I know that people love. They like being a  part of it. They like the idea that they participated in it. I mean, we talked about  them from the very beginning. And so, it makes a difference. It makes a difference in terms of even how people receive the information and additional  information because they understand now the importance of their health. And so  yes, the app, I guess maybe I’ve missed a question, but I just I think that’s part of  it.

Dr. O’Connor: Well, first of all, congratulations to you both because to create a tool that can be  so accessible to so many people, regardless of their socioeconomic status, right  because an app is simple and an app can be free, and, you know, everyone on  the, almost everyone on the planet has a cell phone. 

Dr. LaPrincess Brewer: Yes. 

Dr. O’Connor: They can, you know, put an app on the phone. So that’s just very commendable.  Dr. LaPrincess Brewer: Thank you.

Dr. O’Connor: And I’m really looking forward to following your progress with this and seeing how  that is going to continue to impact communities across our country.

Clarence Jones: Thank you. 

Dr. LaPrincess Brewer: Thank you so much.

Dr. O’Connor: So, Dr. Brewer and Mr. Jones, it’s really been such a pleasure to have you both  join us today. I want to thank you for all that you’ve shared with us, and we hope  that we can continue the conversation on a future occasion.

Clarence Jones: For sure. Thank you.

Dr. LaPrincess Brewer: Thank you for having us and our community.

Dr. O’Connor: Yes, you’re very welcome. And thank you to our listeners for joining us today and  for making the Health Disparities Podcast, one of the world’s leading health  equity podcasts. We’ll be with you again in a couple of weeks. Until then, it’s  goodbye for now. Be safe and be well. 

Jerail Fennell: Thanks so much for listening — and be sure to subscribe to the Health Disparities podcast, wherever you get your podcasts. We’re on Apple, Spotify, and all major podcasting platforms.

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I’m Jerry Fennell. Unt