Working With Faith-Based Communities to Develop an Education Tool kit on Relationships, Sexuality, and Contraception
" Journal of Applied Research on Children: Informing Policy for Children at Risk: Vol. 8 : Iss. 1
Working With Faith-Based Communities to Develop an Education Tool kit on Relationships, Sexuality, and Contraception
Opportunities for Teen Pregnancy Prevention 0
Sheryl B. Bell 0
0 University of Texas Health Science Center at Houston, School of Public Health , USA
Kimberly Johnson-Baker Follow this and additional works at: http://digitalcommons.library.tmc.edu/childrenatrisk Recommended Citation
See next page for additional authors
Funding for this project was provided by the Houston Endowment. We extend a special thank you to our
community liaison Brandi Brown, and the participating pastors, church leaders, and congregants for their
commitment, passion, and insights.
Jennifer Torres, Kimberly Johnson-Baker, Sheryl B. Bell, Jamie Freeny, Sharon Edwards, Susan R. Tortolero,
and Honora I. Swain-Ogbonna
This article is available in Journal of Applied Research on Children: Informing Policy for Children at Risk:
Working With Faith-Based Communities to Develop an
Education Tool kit on Relationships, Sexuality, and
Although historic gains have been made in teen pregnancy prevention,
geographic and racial/ethnic disparities remain a problem.1 Nationwide,
the teen birth rate fell 57% between 1991 and 20132 and decreased
another 9% from 2013 to 2014.1 However, teen birth rates are still
consistently higher in the southern and southwestern regions of the United
States2 than in the rest of the United States, and they are higher among
Black teens than among White teens.1,2 Texas, in particular, continues to
have among the highest teen birth rates in the United States.2 In 2015, the
Texas rate was 34.6 per 1000, compared with the national rate of 22.3 per
1000,so that Texas, along with New Mexico, had the third highest rate in
the United States.3 Furthermore, Black teens in Texas have a higher birth
rate than their White peers (34.3 per 1000 compared with 20.9 per 1000).3
Given the broad effect of teen pregnancy on teen parents and their
children,4 disproportionately affected communities would benefit from
innovative approaches to address teen pregnancy. One such approach is
to build the capacity of faith-based institutions to address the sexual health
needs of their members, especially those that serve high-need
communities. According to the Office of Adolescent Health, faith-based
communities (FBCs) are critical to the sustainability of teen pregnancy
prevention initiatives because they support the role of families in sexual
health development, connect young people to caring adults and
resources, and offer youth services or refer youth and their families to
meet immediate needs.5 Given that the primary reason for the recent
decline in teen pregnancy is attributed to both an increase in teens’ use of
contraceptive methods and an increase in their use of highly effective
methods,6 it is imperative that teen pregnancy prevention efforts within
FBCs include accurate information about effective contraceptive methods.
FBCs provide strong social networks and social capital resources, both of
which are needed to sustain teen pregnancy prevention initiatives. This is
especially true for African-Americans, who attend church more often than
any other racial/ethnic group in the US population.7 Increasingly, FBCs
serving African-Americans seek to provide sexuality education related
primarily to HIV prevention efforts, while balancing their role as purveyors
of morality.8,9 Moreover, research indicates that faith leaders are receptive
to sexual health information that is consistent with the core components of
evidence-based sexual health interventions.10-12 FBCs are well positioned
to influence healthy sexual decision making among teens.13 When teens
were asked in a national survey about factors that influenced their
decisions to engage in sex, most reported that morals, values, and/or
religious beliefs were the most influential.14
Accordingly, there is a need for comprehensive, user-friendly resources
designed for FBCs that provide critical decision-making information related
to pregnancy prevention, including contraception.15 Moore et al outline
strategies for this type of effort, which include equipping church leaders
with appropriate materials and activities “packaged in a tool kit to
efficiently communicate about sex topics.” However, because of the
perceived incongruence of the use of contraception with biblical teachings
and the general levels of distrust based on historical complications, it is
unclear how churches in the African-American community will receive a
tool kit that provides extensive information on sexuality and
This article provides an overview of the development of a sexuality
education tool kit inclusive of contraception for use in a Christian FBC.
The sexuality education tool kit was developed as part of a larger,
community-wide initiative aimed at increasing community support for
greater contraception access for teens and young women residing in an
underserved, predominantly African-American community in southeastern
We describe the development of the sexuality education tool kit in five
) building relationships with faith leaders; (
educational sessions within churches; (
) gaining insight from participating
faith leaders; (
) creating the tool kit; and (
) collecting feedback from
facilitator training and tool kit implementation for future evaluation.
Phases 1 through 3 were conducted according to common principles of
community engagement and participatory action research18 to understand
the current concerns related to teen pregnancy prevention and to ensure
mutuality for moving forward in the design of the sexuality education tool
For phases 4 and 5, we used a theory- and practice-based approach to
develop and implement the sexuality education tool kit. The Social
Cognitive Theory19 and social influence models20 guided content and
structure, which were designed to encourage communication between
parents and youth, healthy relationships, and sexual risk reduction with an
emphasis on contraception. The Social Cognitive Theory posits that
knowledge, self-efficacy, and outcome expectations play an important role
in behavior and acknowledges the significance of role models in the
environment. Social influence interventions emphasize the context of
social interactions and social norms. Social influence models also
informed facilitator training and implementation of the tool kit. We
identified and used key community members in the community who were
capable of influencing others.
The tool kit is also informed by previous practice-based research that
underscores key elements in working with FBCs on sexual health,
including involving FBCs in program development, partnering with a
community liaison, incorporating spirituality and culturally appropriate
messaging, and building the capacity to create a sense of ownership.21
Below we describe the five phases of development of the sexuality
education tool kit.
Phase 1: Building Relationships With Faith Leaders
The first phase of program development – building relationships with faith
leaders – was the most important and the most challenging. Historical and
current-day racism has had a negative effect on the sexual and
reproductive health of African-American women,22 so that a sensitive
approach is required during education around these topics.
AfricanAmericans have a history of distrust of medical research, especially in
regard to contraception. Conspiracy beliefs about fertility regulation and
perceived discrimination are common and play a role in contraception use
among African-American women.17 These factors cannot be ignored in
teen pregnancy prevention efforts and require respectful and honest
dialogue with community leaders. Based on community engagement and
participatory action research,18 we enlisted the help of key members of the
FBC to understand concerns related to teen pregnancy prevention and to
ensure that educational activities and materials were acceptable,
respectful, appropriate, and medically accurate. We also sought the
assistance of a community liaison familiar with church culture to reach out
to local faith leaders who would participate in the piloting of educational
activities. The community liaison connected with faith leaders in the area
and approached the sensitive topic of sexual health education in the
church. During initial meetings, faith leaders reviewed all educational
content, which included topics on healthy relationships; sexual health
(puberty, anatomy, consequences of sex); and contraception. All faith
leaders were receptive to providing the educational content, including the
information on contraception; however, they wanted to ensure that the
greatest emphasis be placed on healthy relationships because they felt
this was a neglected topic in adolescent sexual health development.
Phase 2: Piloting Educational Sessions Within Churches
During phase 2, nine churches agreed to pilot educational sessions for
both parents and youth within their congregations. Experienced educators
from our staff led the sessions. Graduate students were present during
sessions to help take observational notes regarding activity
implementation, participant reaction, and group dynamics. Youth and
parents/adults participated in separate, simultaneous educational
sessions. Each group participated in at least two sessions (in two cases,
the youth requested an additional session). Health educators used a
variety of educational methods during each session, including group
discussion, video/song clips, interactive activities, role plays, and fact
sheets with resources to take home for further discussion. Churches that
participated received a financial incentive.
The parent/adult sessions focused on the importance of age-appropriate
sexuality education inclusive of healthy relationships, puberty,
reproduction, birth control, and strategies for starting and maintaining a
dialogue about healthy sexuality. Although the sessions were
parentfocused, it was important to include other adult influencers, especially
grandparents. Grandparents often have a prominent role in the lives of
their grandchildren and can be willing to have conversations about sexual
risk reduction.23 Including other adult influencers allowed more youth
support and increased awareness among the community as a whole.
The youth sessions focused on characteristics of healthy relationships,
puberty, anatomy and reproduction, and birth control, including
abstinence. The sessions also included an anonymous
question-andanswer portion open to any topic related to sexual health. Participants
were given a message about the importance of seeking information from a
credible and trusted source, preferably a caring adult with whom they
could have conversations related to sexual health.
Phase 3: Gaining Insight From Faith Leaders
For phase 3, faith leaders were invited to participate in a semi-structured,
one-on-one interview to discuss their motivations for participating,
congregant feedback, and their opinions regarding the role of the church
in teen pregnancy prevention.
We conducted interviews with five faith leaders from participating
churches. Interviews were conducted by the community liaison, and notes
were taken by a member of our research team. Major insights emerged in
the following three domains: (
) motivating factors, (
) working through
barriers, and (
) feasibility and sustainability (Table 1). Insights gained
from these interviews were used to inform the development of training
activities, finalize tool kit materials, and plan for future evaluation.
All faith leaders felt that the primary motivating factor for their interest and
participation was to provide education and meet the needs of their
congregants. Many felt that the church has a major role in providing
factbased education, specifically for parents, so that they in turn can provide
their youth with credible information. Although no one cited money as the
primary motivator for participating, two faith leaders said that the financial
incentive they received for participating was helpful, as they often face
financial barriers that prevent them from providing additional educational
programming to their congregants.
All faith leaders were comfortable with the topics covered during the
educational sessions. One faith leader stated that some congregants were
initially concerned that discussing contraception would “invite” youth to
have sex; however, after the first session, they understood the benefit of
youth understanding all the facts related to reproductive health. Faith
leaders reported that the feedback from attendees in phase 2 was
overwhelmingly positive. Adult congregants stressed that the sessions
were much needed, and that if they had received the same information
when they were young, they might have made more informed choices.
When asked about comfort with the inclusion of contraception, church
leaders ultimately deferred to their responsibility to provide current,
factbased information to their congregation. One faith leader stated that even
though discussing prevention methods like condoms and contraception
conflicted with church teachings, he felt that parents had every right to do
so. He even mentioned that as a father, his message would be different
from his message as a faith leader.
All faith leaders agreed that training their congregants is key to ensuring
that they continue to implement activities. Some also felt that having an
outside agency provide the information ensured credibility and accuracy.
Major Insights Quotes
A. The role of the I am not an expert on sexuality, I try to be an
church is to educate expert in the preaching of God’s word, if we
everyone, including don’t talk to young people about these topics,
pastors, youth statistics will continue to increase, we have to
ministers, parents, educate.
and youth by
providing fact-based I believe what the Bible says as far as
information. edifying, giving hope, sharing knowledge;
what motivated me was the knowledge piece,
I believed parents would gain from having this information.
Youth ministers and workers need to be educated in order to provide factual information and guidance to youth in the church.
B. It is critical to meet Everything starts in church. Church is to be
the various needs of the foundation, pastors back in the day talked
those they serve. about everything, whatever people needed.
Any topic you talk about, BC, sex awareness, etc is appropriate.
The church is a spiritual place but obviously we have to be able to understand that Christ addressed all the needs of people.
The need is the motivation, and the [offer of] finances made it clear.
Comfortable with I feel that healthy relationships, healthy
topics, but concerned communication, puberty, and anatomy are
about initial parent most important; however, I don’t think any of it
reaction and message makes me uncomfortable, not even
delivery (having leaders contraceptives … we have parents who may
participate in training rebel, but if you talk to me I will intervene to
would alleviate this make it happen.
Feasibility and Training in-house
Sustainability membership is critical to
ensure credibility and
We got all positive comments after they
participated in the sessions, some were
reluctant and did not feel the topics were
appropriate but after they heard about what
was said they felt better.
Sometimes we need to take people out of their comfort zone. If we can keep giving knowledge to the generation under us they can carry it on.
I would be comfortable having some of my people
trained, getting educated and gaining knowledge
on the topic; they would be able to help the
congregation and others they come across in the
wider community. I don’t think there is anything
that would prevent me from offering this sort of
I think it would be good to train someone
internally, I would be comfortable having teen
leaders learning so they can deliver the message
and training … I would not do it because I cannot
do everything and pastors already have a lot of
Phase 4: Finalizing the Tool Kit
In phase 4, the sexuality education tool kit is informed by evidence,
theory-based strategies, and feedback from phases 1, 2, and 3. It
comprises seven 1-hour sessions for youth and nine 1-hour sessions for
The youth sessions (Table 2) are designed to increase knowledge of the
characteristics of healthy relationships, puberty, anatomy and
reproduction, and effective methods for reducing sexually transmitted
infections and unplanned pregnancy. They are also designed to address
attitudes toward healthy decision making related to sexual behavior,
encourage critical thinking, and offer local resources (ie, clinical services).
Session 1. Healthy relationships: What is healthy?
Session 2. Healthy relationships: Consent
Session 3. Know your body: Puberty
Session 4. Know your body: Anatomy and reproduction
Session 5. Making responsible decisions: Abstinence
Session 6. Making responsible decisions: Preventing HIV/sexually
transmitted infections (STIs)
Session 7. Making responsible decisions: Birth control
The parent/adult sessions (Table 3) are designed to build comfort and
confidence when they provide youth with age-appropriate, medically
accurate information related to sexual health. Recurring messages
throughout all sessions prompt adults to give open and honest responses
to youth questions, avoid judgment and shaming, and stay engaged in the
lives of their youth. The tool kit also includes an optional session on faith
and adolescent sexuality; this includes a study guide containing Bible
verses and discussion questions that support adolescent sexual health
Session 1. Healthy relationships: What is healthy?
Session 2. Healthy relationships: Setting personal boundaries
Session 3. Healthy relationships: Consent
Session 4. Healthy relationships: Abstinence and the consequences of sex
Session 5. Healthy relationships: Birth control
Session 6. Knowing how the body works: Anatomy
Session 7. Knowing how the body works—Puberty, menstruation, and
Session 8. Having the conversation, Part I: What to say
Session 9. Having the conversation, Part II: How to say it
Optional: Faith and adolescent sexuality study guide
Phase 5: Tool Kit Training and Implementation
During phase 5, we trained selected members of the church to facilitate
use of the sexuality education tool kit, monitored implementation, and
collected feedback to inform future evaluation. The selection of facilitators
was determined by guidance from the pastor on the basis of their role in
the church as respected, influential members in the community. A 1-day
session was held with facilitators to train them on the contents of the tool
kit and share lessons learned from phase 2. We trained 14 facilitators,
who represented six churches, to implement the tool kit during the
summer of 2016. A total of four churches implemented the tool kit. Two
churches did not implement (in one case because of facilitator health
issues; the other did not provide a reason).
After the tool kit implementation, we collected 11 reaction surveys from
participating youth (82% female) and 23 parents/adults (78% female). All
participants were African-American. After attending the tool kit sessions,
all adult participants reported that they felt more comfortable talking about
healthy relationships, consent, puberty, reproduction, sexually transmitted
infection (STI) transmission and prevention, and birth control. Among
youth, 72% reported that they were more knowledgeable about healthy
relationships, consent, reproduction, and STDs. In addition, we received
promising feedback about intended condom use (82%), clinic use (64%),
and birth control use (91%) if youth chose to have sex. This feedback
warrants a full-scale evaluation of the sexuality education tool kit for FBCs.
Facilitators participated in a post-implementation focus group and
provided the research team with feedback on successes, challenges, and
suggestions for improvement (Table 4).
Overall, the facilitators had a positive experience with implementation and
felt that the training was beneficial for building confidence and learning
from others. They said the sessions were informational and well received
by attendees. Facilitators were encouraged by the eagerness of youth to
share information with peers. One youth used Snapchat to share part of
the session with her friends, while another called her partner on the phone
during the discussion about consent so he could listen in real time. It was
reported that adults also appreciated the tool kit sessions, especially those
on healthy relationships, acknowledging that the sessions helped them
evaluate their own adult relationships.
A few challenges were noted. Facilitators reported that both adults and
youth had difficulty with the concept of active consent in sexual situations
and felt that one session did not allow enough time to address the topic
thoroughly. The topic of anatomy and reproduction was also challenging
for some facilitators because it was difficult to manage youth of varying
ages and levels of maturity. Also, a few males (both adult and youth) did
not want to learn about male body parts with the illustrated graphics.
Another challenge for facilitators was attaining parental permission. This
was because parents are often not present or involved in youth-centered,
after-school, and summer activities.
Despite the challenges, most of the facilitators were not deterred from
continuing to use the tool kit and offered suggestions to consider for future
facilitators and future iterations of the tool kit. All facilitators felt it was
important to inform parents adequately and acquire written permission for
youth participation. They also felt it was important to “make it fun” for the
youth by including music and snacks, and to incorporate technology into
the educational sessions.
Training was a good opportunity to learn from other facilitators.
Very informational; participants enjoyed it and thought more people
need to hear it.
Some adults realized that their own relationship was not healthy.
Youth saw it as an opportunity to share information with friends.
Consent – participants (both parents/adults and youth) were reluctant
to accept that “no response” means “no.”
Parent permission was difficult to get because parents are not always
involved in church.
When it came to anatomy, some male adults didn’t want to know
about male body parts.
Be prepared for parents to think you’re teaching kids how to have sex.
Get written parent permission.
Make it fun – have snacks and music, and include technology.
We have described a theory- and practice-based approach to develop and
implement a sexual education tool kit with an FBC in an underserved,
predominantly African-American community in southeastern Texas. The
approach of addressing sexual health in FBCs has substantial
support,5,715,21 and this process confirmed its feasibility and acceptability.
Our formative work could be useful for health professionals using this
strategy. The following are lessons learned for health professionals
planning to work in FBCs:
Find an appropriate community liaison. Our work would not have
been possible without a community liaison who was familiar with
church culture and who had a prominent and respected role in the
community. The liaison enlisted the involvement of faith leaders
who otherwise might not have been receptive to allowing our staff
to work with their congregants.
Work alongside the FBC from beginning to end to ensure that the
intervention is culturally appropriate. For example, the initial goal of
the tool kit was to focus mainly on contraception; however, after
initial feedback and collaboration with faith leaders, more emphasis
was placed on healthy relationships and consent, as these topics
are often neglected but necessary to frame adolescent sexual
health decision making. Within this framework, it was acceptable to
educate about contraception.
Clearly define the target population. It is not uncommon for families
to travel to another community to attend church; therefore, working
with a particular FBC does not guarantee that the surrounding
community is exclusively being served by that FBC. Additionally,
youth involvement in an FBC does not guarantee parent
Choose health professionals/educators who are comfortable and
willing to participate in church activities. Our research staff was
often included in group prayers and church services, and they had
to be comfortable addressing questions about faith and sexuality.
Thus, health professionals/educators must have a genuine respect
for religious values to partner with FBCs effectively.
The unique social engagement and support network that exist in FBCs
create an ideal environment for health promotion. Future steps for the
research team will include an evaluation of the sexuality education tool kit
with FBCs and the implications for dissemination if it is found to be
In this project, we affirmed the willingness of FBCs to meet the sexual
health needs of youth and their families. Faith leaders faced barriers
similar to those reported in previous studies, including initial discomfort
regarding sexual health topics and perceived opposition from the
community.11 However, faith leaders remained motivated to overcome
barriers by their mission to serve their communities. A sexuality education
tool kit that is respectful and guided by the input of an FBC can be a viable
and innovative approach to address teen pregnancy.
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