Implementing health promotion activities using community-engaged approaches in Asian American faith-based organizations in New York City and New Jersey

TBM ORIGINAL RESEARCH Implementing health promotion activities using community-engaged approaches in Asian American faith-based organizations in New York City and New Jersey 1 Department of Population Health, NYU School of Medicine, 550 First Avenue, VZN, 8th Floor, New York, NY, USA 2 Kalusugan Coalition, Inc., New York, NY, USA 3 Korean Community Services of Metropolitan NY, Inc., New York, NY, USA 4 UNITED SIKHS, New York, NY, USA Correspondence to: S Patel Cite this as: TBM 2017;7:444–466 doi: 10.1007/s13142-017-0506-0 # Society of Behavioral Medicine 2017 Abstract Faith-based organizations (FBOs) (e.g., churches, mosques, and gurdwaras) can play a vital role in health promotion. The Racial and Ethnic Approaches to Community Health for Asian Americans (REACH FAR) Project is implementing a multi-level and evidence-based health promotion and hypertension (HTN) control program in faith-based organizations serving Asian American (AA) communities (Bangladeshi, Filipino, Korean, Asian Indian) across multiple denominations (Christian, Muslim, and Sikh) in New York/New Jersey (NY/NJ). This paper presents baseline results and describes the cultural adaptation and implementation process of the REACH FAR program across diverse FBOs and religious denominations serving AA subgroups. Working with 12 FBOs, informed by implementation research and guided by a cultural adaptation framework and communityengaged approaches, REACH FAR strategies included (1) implementing healthy food policies for communal meals and (2) delivering a culturally-linguistically adapted HTN management coaching program. Using the Ecological Validity Model (EVM), the program was culturally adapted across congregation and faith settings. Baseline measures include (i) Congregant surveys assessing social norms and diet (n = 946), (ii) HTN participant program surveys (n = 725), (iii) FBO environmental strategy checklists (n = 13), and (iv) community partner in-depth interviews assessing project feasibility (n = 5). We describe the adaptation process and baseline assessments of FBOs. In year 1, we reached 3790 (nutritional strategies) and 725 (HTN program) via AA FBO sites. Most AA FBOs lack nutrition policies and present prime opportunities for evidence-based multi-level interventions. REACH FAR presents a promising health promotion implementation program that may result in significant community reach. Keywords Asian American, Implementation, Faith-based, Health promotion, Cultural adaptation page 444 of 466 Implications Practice: Faith-based organizations, across religious denominations and congregation size and structures, can serve as key implementation sites for health promotion and disease prevention to reach underserved Asian American populations. Policy: In general, Asian American-serving faithbased organizations lack organizational-level nutrition policies but are receptive to enacting such policies. Research: There is a need to systematically adapt evidence-based programs for underserved communities using community-engaged approaches. Future research should identify key organizationallevel factors of faith-based organizations to enhance and sustain successful uptake of health promotion strategies and programs. BACKGROUND In the United States (US), nearly one-third of adults have hypertension (HTN), and cardiovascular disease (CVD) is the leading cause of death [1–3]. Fewer than half of individuals with HTN are under control despite widely available and affordable medications [4, 5]. Moreover, rates of poor control and complications are disproportionately high in some racial/ethnic communities, including Asian Americans (AAs) [6, 7]. For example, Jose et al. [8] examined CVD mortality rates by AA subgroup from the Multiple Cause of Death mortality database 2003–2010 from the National Center for Health Statistics and found that the proportionate mortality burden of hypertensive heart disease and cerebrovascular disease, especially hemorrhagic stroke, was higher in every AA subgroup (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) compared to non-Hispanic whites [8]. AAs comprise 5.6% of the US population, corresponding to about 14 million people [9]. They are the TBM SC Kwon, DrPH, MPH,1 S Patel, MPH,1 C Choy, MPH,1 J Zanowiak, MA,1 C Rideout, MPH,1 S Yi, PhD,1 L Wyatt, MPH,1 MD Taher, MPH,1 MJ Garcia-Dia, DNP, RN,2 SS Kim, MPH,3 TK Denholm, MSEd,3 R Kavathe, PhD,4 NS Islam, PhD1 ORIGINAL RESEARCH TBM The goal of this paper is to describe the efforts of a multi-sector coalition representing diverse AA communities in New York City and New Jersey (NYC/NJ) to adapt and implement multi-level strategies to address HTN control, HTN management, and CVD prevention. Specifically, these strategies have been culturally adapted and integrated to enhance community fit, preferences, and priorities for sustainable implementation. We present baseline results and describe the adaptation process for the implementation of (1) environmental and policy strategies to improve access to healthy foods and beverages and (2) a volunteer-led blood pressure monitoring program in FBO settings in NYC/NJ. METHODS Project description Building upon a substantial history of communityengaged health promotion and prevention efforts in the AA community [55–57], the Racial and Ethnic Approaches to Community Health for Asian Americans (REACH FAR) program is guided by a multisector coalition consisting of a lead academic agency, four community-based organizations (CBOs) and groups representing the Asian Indian, Bangladeshi, Filipino, and Korean communities in NYC/NJ, and state and local health departments. Coalition partners leveraged their deep roots in the community, bolstered with technical assistance, training, and resources, to further engage 12 FBO sites in health promotion and prevention strategies. Coalition partners are described in Table 1 below and elsewhere [40, 55–66]. The coalition worked with FBO sites to implement multi-level strategies that addressed both organizational change and individual and interpersonal behavior change to support HTN prevention and management. At the organizational level, the REACH FAR coalition worked with FBO sites to implement environmental and policy change to increase access to heart healthy foods and beverages served during congregation meals. These changes included the introduction of one or more of the following options during communal meals: (1) one fruit choice, (2) one leafy green salad or fresh vegetable, (3) one whole grain option (e.g., brown rice, whole wheat naan), (4) water availability at no charge at meal time, (5) 1% or non-fat milk/yogurt, and (5) low-sodium dressings/condiments (e.g., soy sauce, lemon, salad dressing). To facilitate community-clinical linkages and to increase individual-level awareness of the importance of blood pressure control, the FBO sites also implemented a NYC Department of Health and Mental Hygiene (DOHMH) program, BKeep on (...truncated)