Perspectives of African American Church Leaders in Response to COVID-19 Emergency Preparedness and Risk Communication Efforts Within a Community Engaged Research Partnership: COVID-19 emergency risk communication

African-American Churches are Key Partners in Addressing Health Challenges

The COVID-19 pandemic disproportionately affected communities of color, particularly African-Americans (AAs), exacerbating health disparities. ¹ Since 78% of AAs report belonging to religious organizations, the Fostering African-American Improvement in Total Health! (FAITH!) Program leveraged a successful, longstanding community-academic partnership in April 2020, ^2–6 by providing emergency preparedness (EP) plans and COVID-19 information to AA churches in Rochester and Minneapolis-St. Paul (MSP), MN. ⁷ This mixed-methods study evaluated the initiative’s impact on EP promotion within AA communities during the pandemic; assessing church readiness for future public health emergencies, intervention engagement, dissemination, and satisfaction.

Methods

Intervention/Context

From April to May 2020, an 8-week EP risk communication intervention was co-developed with AA churches in Rochester and MSP (AAs 9.1% and 18.4% of population, respectively). In the intervention areas, an estimated 60% of AAs attend Christian congregations. Employing a community-based participatory research approach and a framework adapted from the Centers for Disease Control and Prevention (CDC) Crisis and Emergency Risk Communication framework, a needs assessment was conducted to understand pandemic-related challenges faced by the AA community. Intervention details have been previously published. ⁷ Based on the needs assessment, a faith-based, COVID-19 EP manual was electronically communicated. ⁷ The manual offered step-by-step guidance for structuring church EP initiatives and establishing EP teams (EPTs). Additionally, a culturally tailored social marketing campaign was launched to communicate inspirational, health, and financial, as well as social support messages. The “FAITH! & COVID-19 Spread the Word!” newsletter, co-developed with community leaders, was sent weekly to congregations via email containing scripture-based information to reinforce messages.

Data Collection

The Mayo Clinic Institutional Review Board approved this study. Following informed consent, AA church leaders participated in individual, 1-hour, semi-structured interviews (June–July 2020) via videoconferencing and telephone using a standardized moderator guide. All interviews were recorded and transcribed. Participants received US $50 cash card for interview completion. Churches also received US $500 monetary incentives to enhance EPTs.

Outcomes

We assessed whether churches had an established EPT and the perceived level of church EP at pre- and post-intervention. Furthermore, the intervention was evaluated on engagement, dissemination, satisfaction, and recommendations/suggestions for sustainability.

Analyses

Participant characteristics were summarized using mean, median, and proportions. Initial themes and categories were compiled using an integrated approach of inductive codes emerging from the data and a priori codes derived from interview questions. Multiple readings were conducted to identify preliminary themes. Quantitative analysis utilized SPSS Statistics Version 25 (IBM Corp., Armonk, NY, USA) and qualitative analysis used QSR NVivo software, v10 (Doncaster, Victoria, Australia).

Results

Quantitative Results

Fifteen church leaders were interviewed (response rate: 47% [15 / 32 churches]). Mean age was 60 (SD 9.3) years, with a majority being women (n = 12, 80%). Most were pastors and health coordinators (n = 8, 54%). Representing churches were mainly in MSP (n = 12, 80%); and the median congregation size was 85 members.

Table 1 displays church EP and intervention evaluation. Pre-intervention, 73% (n = 11) of the churches had a health ministry, while only 27% (n = 4) had an established EPT. About 40% (n = 4) of church leaders felt their churches were prepared for a health crisis. Post-intervention, 73% (n = 11) had established an EPT (or equivalent structure), and 3 leaders planned future EPTs. All 15 churches reported increased readiness for the ongoing pandemic and future health crises.

Table 1. Church emergency preparedness and evaluation of the FAITH! emergency preparedness and risk communication initiative

The FAITH! EP intervention (n = 8, 53%) ranked among the top 3 reliable COVID-19 information sources, alongside the governor’s briefings (n = 8, 53%) and the CDC (n = 7, 47%). Of 13 leaders receiving weekly emails, 85% (n = 11) shared information with their congregations. Among 7 churches receiving the EP manual, 57% (n = 4) used it to establish or enhance EPTs. Although 67% (n = 10) knew of the FAITH! Facebook page, only 30% (n = 3) interacted with its content. All leaders who received emails and the EP manual found them helpful for mitigating the pandemic.

Qualitative Results

Thematic analysis of semi-structured interviews yielded 4 themes (Table 2) with no differences by interview mode (videoconferencing vs. telephone).

Table 2. Perceptions of FAITH! emergency preparedness and risk communication initiative

“Perceived Level of Church EP” indicated pre-intervention unpreparedness for health crises like the pandemic. Improved EP post-intervention was attributed to adherence to recommended standards, enhanced knowledge, technology integration, and better communication strategies.

“Intervention Engagement/ Dissemination” underscored the EP manual’s adaptability and its role in launching EPTs. The majority of church leaders valued the weekly emails, finding them highly informative and relevant in addressing pandemic-related needs. Instead of forwarding the emails, leaders often summarized key points for distribution through church communication channels (e.g., email and websites).

“Intervention Satisfaction” revealed that the FAITH! EP intervention significantly impacted EP via the manual. The manual was praised for its accessibility and cultural appropriateness, although some participants cited time constraints and pandemic-related demands as hindrances to fully reviewing and implementing its contents.

The “Intervention Sustainability” theme featured church leaders’ recommendations for long-term impact. They proposed sustaining the intervention by including community health needs (e.g., cancer screening), expanding prevention efforts (e.g., distributing hand sanitizers), incorporating non-COVID-19 healthy lifestyle information, and converting the manual into webinars for increased accessibility.

Discussion

This community-centric intervention improved EP in AA churches by establishing new, and enhancing existing EPTs for health crises, including infectious disease outbreaks. The COVID-19 EP manual aided crisis mitigation efforts led by the EPTs. Participants found the intervention messaging reliable and useful. Similar initiatives addressed vulnerable communities’ needs elsewhere in the US but lacked an EP focus. ^8,9 This study underscores the need for immediately deployable, sustainable EP tools (e.g., the FAITH! EP intervention) for church leaders to effectively navigate disasters and keep parishioners safe.

The small sample size and localized geographic region limits generalizability of findings beyond these communities. Nevertheless, we achieved interview saturation, underscoring the validity of the findings and offering valuable insights for enhancing EP in under-resourced AA communities. Effective information communication is crucial in the digital transformation era. Participants recommended concise formats, leading to a FAITH! program webinar series covering EP essentials. This highlighted the need for user-friendly digital toolkits in future interventions. Importantly, contextualizing EP strategies is crucial, particularly in socioeconomically disadvantaged communities where unmet or neglected needs are prevalent. ¹⁰

Conclusion

Equipping churches equitably with EP resources and tailoring resources through EP assessment are pivotal for effective crisis response in AA communities.