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The Black Church and Public Health: A Key Partnership for Theory Driven COVID-19 Recovery Efforts

The COVID-19 epidemic has negatively impacted the Black community in the United States. Despite current disease mitigation efforts, work is still needed to ensure that Black individuals living in the United States understand their risks regarding COVID-19 infection whether vaccinated or unvaccinated. Thus, the current article posits that the Black church, in concert with public health practitioners, is a venue through which theoretically based health messages should be designed and disseminated regarding COVID-19 recovery efforts. The Health Belief Model and the Harm Reduction approach are posed as theoretical frameworks to facilitate the design of such messages.


Commentaries
Churches and faith-based organizations are a trusted resource for Black communities in the United States and have a potentially influential role amidst coronavirus-19 (COVID-19) recovery efforts. 1 Research conducted at the beginning of the COVID-19 pandemic in the United States, revealed Black respondents (45.9%) reported less worry regarding potential infection compared to white people (32.0%) and members of other racial/ethnic groups (35.3%). 2 Despite this initial optimism, the Black community has undoubtably been negatively impacted by the current pandemic. 3 Researchers have argued that the devastating impact of COVID-19 among Black people can be traced to pre-existing health and social conditions 4,5 including being employed at jobs in which they cannot work from home, such as essential industries with high levels of public interaction. 6 Currently much of the efforts to combat COVID- 19 have transitioned to vaccination uptake (including boosters) as state-at-home orders and restrictions have been lifted. However, for Black Americans, it is necessary to continue to focus on both risk reducing behaviors (ie, social distancing, hand sanitizing, and mask wearing) as well as vaccination education.
Amid a nationwide COVID-19 vaccine and booster rollout, guidance is needed to ensure one of the most vulnerable groups of the U.S. population has information to facilitate informed decisions. According to the Centers for Disease Control and Prevention (CDC) as of April 7, 2022, approximately 42% (41.5%) of Black Americans aged 18 and older in the United States are fully vaccinated; with 47.5% of this group having received at least 1 dose of the COVID-19 vaccine. 7 Although vaccination efforts are in progress, COVID-19 variants, including the highly contagious Omicron variant are slated to impact the unvaccinated population the hardest and could be particularly harmful to those of African American descent. 8 Efforts to reduce COVID-19 disparities should involve Black churches as these organizations are committed to their congregations, have been previously utilized in health education efforts, 9 and have been proven successful in encouraging church members and the larger community to support health initiatives. 10 Public health partnerships with faith-based organizations are an avenue to consider when addressing COVID-19 related disparities as churches are typically embedded within the local community and often perceived as trustworthy health information sources. 11 Given these reasons, the objective of this essay is to explain how Black churches, in concert with local public health officials, are feasible vehicles to disseminate theoretically based health messages to mitigate COVID-19 infections. These church-public health partnerships can also provide information to allow informed vaccine decision-making among Black people living in the United States.

Effective Faith-Based Interventions
In the United States, Black people attend church more than any other racial/ethnic group. 12 Previous research has linked regular church attendance to healthy behavior such as blood pressure screening, dental cleanings, and pap smears. 13 A review of church-based health interventions also revealed that faith-based health promotion programs can be effective, particularly regarding heart health, dietary improvement, weight loss, as well as improving cancer knowledge and increasing cancer screening rates. 14 Consequentially, faith-based organizations can be effective in addressing the COVID-19 crisis.

Black Church Leadership and Structure
Church organizational structure and leaders position the Black church as a relevant entity to reach the target population. Black pastors acknowledge their influential role in promoting and modeling healthy behavior as well as the importance of faith-based programs in improving health among congregants. 10,15 For instance, diabetes prevention programs have been translated to faith-settings and have been proven to be successful in achieving weight loss and lowering fasting glucose levels among Black congregants. 16 Body and Soul, a church-based nutrition intervention, used existing church organizational structures and practices to significantly increase fruit and vegetable intake among participants. 17 Important components of this intervention included speaking about fruit and vegetable intake in sermons and discussing healthful eating regularly. Similar techniques could be employed to address reducing COVID-19 infections. The organizational members and structures of Black churches (eg, pastors, health ministries, etc.) in conjunction with the information and messaging expertise of public health practitioners should be utilized to address COVID-19 information dissemination and subsequent behavioral change as it has been used previously to address other health issues.

Current Health Messages From Black Churches
During the COVID-19 pandemic, many face-to-face church services initially transitioned to online modalities due to statewide mandates related to social distancing. Many obstacles were presented with the transitioning to virtual services: (1) differences in experiences when compared to traditional in-person services; (2) loss of revenue to cover church expenses; and (3) limited technological capacity. 18 However, many pastors of predominantly Black churches stood firm that services would remain in the virtual format due to COVID-19 concerns. Rev. Reginald Sharpe, Jr. of Fellowship Missionary Baptist Church in Chicago, Illinois stated the following during a virtual service on Sunday, May 17, 2020, regarding when in-person services at his predominately Black congregation would resume: "The church is still open; the building is closed. You don't have to call us. You don't have to e-mail me. You don't have to DM me, we ain't comin' back up in here until it is absolutely safe." 19 Declarative statements from Black pastors sent appropriate health messages about the seriousness of COVID-19 to both parishioners and the larger Black community who depend on the church for other resources outside of spiritual guidance. The opportunity to capitalize off the shared mission of both Black churches and the public health community to continue to protect Black Americans, is now.

Black Churches Still Serving During the Pandemic
Some Black churches have already used their platforms to provide COVID-19 information but also serve as a model for appropriate behavior during the pandemic. 20 The utilization of social media platforms by Black churches to communicate with their congregations helps to reduce health risk. Many congregations have held church services via Facebook Live, Zoom, and outside of the sanctuary, where members can listen in their cars on the radio, or sit in lawn chairs while social distancing. 21 At the time of this writing, Black people in the United States are likely to attend church service in various modalities including in-person, virtual, or sometimes alternating between the 2 modalities. 22 Providing testing, presenting vaccine information, as well as serving as vaccination sites sends several health messages: (1) COVID-19 continues to be a real health concern and (2) your local Black church (whether in-person or virtual) is still a resource. Public health experts can help Black churches expand their commitment and effectiveness in combating the spread of COVID-19 among Black Americans by aiding with health message design.

Next Steps for Black Churches
We argue for the establishment of additional formal and collaborative partnerships between churches and public health professionals to do the following: (1) develop and disseminate messages regarding how to reduce risk of COVID-19 infection, (2) facilitate informed decision-making regarding vaccine (including boosters) uptake, and (3) discuss risk of COVID-19 infection after reaching full vaccination status. Unfortunately, messages and information disseminated by the CDC and other public health organizations have not translated to reduction in infection and vaccination uptake among Black Americans and grassroots organizations have had issues securing funding to reach their local communities. 23 Utilization of public health professionals in conjunction with more trusted entities, like the Black church, is important as the closure and phased re-opening efforts of Black churches will continue to impact parishioners, particularly older Black Americans who are among the most vulnerable and rely on the Black church as a resource. 24 In the initial months of the COVID-19 pandemic in the United States, public health researchers and Black churches joined forces to assess emergency preparedness via listserv/social media postings and assessed the impact of those messages via measurements of reach/engagement, feasibility, and acceptibility. 25 Moving forward, public health professionals can still facilitate designing theoretically based messages and supplement dissemination strategies within the Black community. In addition to current messages addressing COVID-19, Black churches may: (1) host information sessions; (2) include messages in bulletins, on calling posts, and on social media accounts; (3) incorporate messages into other church initiatives (eg, during feeding the hungry/ unhoused or prison ministry visits); and/or (4) provide space for local health departments who provide health services related and unrelated to COVID-19. Each of these will send clear messages on the church's stance on COVID-19. To increase the effectiveness of these messages, using theoretical frameworks in the development and dissemination is critical. Based upon previous research, 2 frameworks that could be utilized in this process include the Health Belief Model 26 and the Harm Reduction Approach. 27

Theoretical Messaging to be Used by Black Churches
The HBM outlines several factors that seek to predict why people will take action to reduce a potential health risk: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. The HBM articulates the relationship between perceived threat and health behavior. Given the current pandemic, perceived threat could be comprised of many of the following factors: perceived health status as well as the likelihood of engaging in behavior to reduce the risk of spreading the disease including (a) utilizing protective equipment (such as face coverings and hand sanitization products), (b) practicing appropriate social distancing, (c) engaging in effective hand wash hygiene, and (d) taking the COVID-19 vaccine. For example, the perceived barriers and benefits of masking, social distancing, and/or vaccine update (outcome behaviors) among individuals could be evaluated. According to a meta-analysis of studies guided by HBM, messages that focus on perceived benefits and perceived barriers are associated with the enaction of preventative behaviors regarding a health threat such as COVID-19. 28 Messages designed utilizing the HBM as a framework would provide guidance for those considering the resumption activities outside of work, particularly as most states have loosened or fully removed statewide mask mandates. Messages focused on providing accurate disease information as well as those articulating risks associated with contracting the disease are predicted to increase preventative behaviors (eg, social distancing, wearing masks, quarantining, and taking the COVID-19 vaccine). These types of messages could be utilized by church health ministries to reach their parishioners as well as the local community the church serves. Input from public health professionals can also help address barriers to preventative behaviors through message design.
The Harm Reduction Approach is a public health strategy that allows individuals to continue engaging in risky behaviors but provides ways to reduce negative health outcomes associated with those activities. 29 Early work utilizing this approach was focused reducing risky health behaviors amidst the HIV/AIDS pandemic. 27 Messages designed utilizing the Harm Reduction Approach would offer guidance for those who continue to work in essential industries as well as those who have been vaccinated.
Messages developed from the Harm Reduction approach would provide guidance individuals who choose or are required engage in behaviors that put them at risk for COVID-19 infection. For example, individuals who work in essential industries can continue to take action (including taking a vaccine, wearing a mask, and practicing good hand hygiene) to reduce their risk of infection. Moreover, individuals who would like to resume regular social activities such as eating out could take actions such as visiting restaurants at non-peak times or opting to eat outside or ordering takeout. Information about resuming social activities as well as attendance at in-person church events, could be disseminated by church health ministries. Public health professionals could help churches design targeted messages to resonate with church and community members to assist them in making socialization and work-related decisions while being informed of the risk of doing so, even if they are fully vaccinated, as breakthrough cases are expected and have been reported. 7 The HBM and Harm Reduction Approach have been posed as key theoretical approaches to assist with COVID-19 risk reduction. 30,31 However, the establishment of strong church-public health partnerships are integral in ensuring such messages are crafted and disseminated in a way to influence the target audience through a trusted voice in the Black community, the Black church. Scholars have articulated the benefits, challenges, and best practices regarding public health practitioner and church partnerships. 32,33 Thus, it is imperative that health messages stemming from the church, in rhetoric and practice, reinforce messages from public health experts during a pandemic that continues to disproportionately impact the Black community.

Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.