Faith, Activity, and Nutrition
- Need: To increase healthy eating and physical activity levels in Fairfield County, South Carolina.
- Intervention: Community health advisors train church committees and deliver telephone-based technical assistance to improve opportunities, guidelines, messages, and pastor support for physical activity and healthy eating.
- Results: In a 2018 study, churchgoers reported seeing more opportunities for physical activity as well as more messages and pastor support for physical activity and healthy eating. Intervention churches also had fewer inactive churchgoers, compared to control churches.
Evidence-levelPromising (About evidence-level criteria)
According to County Health Rankings & Roadmaps, Fairfield County, South Carolina, is ranked 36th in health outcomes out of 46 counties. Ranking factors include adult obesity (42% of Fairfield County adults are considered obese, compared to a statewide average of 33%) and poor access to exercise opportunities (32% of the county population has access to places for physical activity, compared to a statewide average of 68%).
Faith, Activity, and Nutrition (FAN) works to improve church environments' opportunities for physical activity and healthy eating with the goal of improving health behaviors and health outcomes. FAN works with churches of multiple denominations; 57.4% of the county population is African American. Trained laypeople called community health advisors (CHAs) deliver a one-day training to church committees of 3 to 5 volunteers, including pastors, to encourage healthy eating and physical activity among churchgoers and incorporate healthy choices into church activities. A program coordinator in the church coordinates the activities that churches put into place. The CHAs provide brief technical assistance calls to pastors and the church program coordinator over 12 months.
The CHAs are trained for this role through online training modules and a one-day, in-person training. These CHAs then receive booster trainings three times during the year to support them in their role of working with the churches.
FAN partners include Fairfield Behavioral Health Services and Fairfield Forward. Training for church committees is conducted in the local district office. The University of South Carolina Prevention Research Center received a 2014-2019 CDC grant to be one of 26 Health Promotion and Disease Prevention Research Centers. This funding supported its study of the program's dissemination, implementation, and effectiveness.
The University of South Carolina Prevention Research Center received a 2019-2024 CDC grant to conduct a national implementation study of FAN. The church committee training has been converted to an online program and will be evaluated in up to 100 churches across the United States. The online training will be available starting in the fall of 2020.
CHAs deliver a one-day training to church committees and provide one year of technical assistance via monthly phone calls. During the training, participating church committees learn about the following topics concerning healthy eating and physical activity:
- Creating opportunities for healthy eating and physical activity before, during, or after church events
- Setting guidelines and policies for healthy eating and physical activity
- Sharing messages (such as bulletin inserts) about healthy eating and physical activity with churchgoers
After the training, church committees create a church program plan and budget, host a kick-off event for the congregation, hold regular committee meetings, and implement the new programming.
In a 2018 dissemination and implementation study, 42% of the county's churches received training, and 1,308 churchgoers completed questionnaires about their fruit and vegetable intake, physical activity levels, and perceptions of their church environment:
- 71.68% of the intervention group reported seeing fruits and vegetables offered at church events "almost all of the time," compared to 62.63% of the control group
- 27.2% of the intervention group reported eating the recommended amount of fruits and vegetables, compared to 24.2% of the control group
- 9.8% of the intervention group reported being inactive, compared to 15.7% of the control group
In a 2018 study describing the CHAs, church committee members were asked at the end of the training if they agree or disagree with statements in the evaluation (1 = strongly disagree, 4 = strongly agree). The following are the mean scores of the intervention group's and control group's response (the control group received the same training one year after the intervention group):
- 3.56 (intervention) and 3.51 (control): "I am confident that I have the skills to put the physical activity part of the program in place in my church"
- 3.53 (intervention) and 3.45 (control): "I am confident that I have the skills to put the healthy eating part of the program in place in my church"
Phase 1 of this program targeted Fairfield County, while Phase 2 implemented FAN statewide through the South Carolina United Methodist Conference. A 2020 Translational Behavioral Medicine article indicated that Phase 2 led to significant improvements (from pre-training to 12 months post-training) in messages, opportunities, policies, and pastor support for physical activity and healthy eating.
A 2020 Frontiers in Public Health article examined the organizational maintenance of FAN in Fairfield County churches. Results indicated that implementation of physical activity and healthy eating components at 24 months was significantly greater compared to pre-training. Two years after FAN implementation, most churches kept at least one program component going.
FAN is indexed in the National Cancer Institute's Evidence-Based Cancer Control Programs, based on its 2013 study.
For more detailed information on program results:
Wilcox, S., Saunders, R.P., Jake-Schoffman, D., & Hutto, B. (2020). The Faith, Activity, and Nutrition (FAN) Dissemination and Implementation Study: 24-Month Organizational Maintenance in a Countywide Initiative. Frontiers in Public Health, 8, 171.
Wilcox, S., Jake-Schoffman, D.E., Saunders, R.P., Kinnard, D., Kaczynski, A.T., Hutto, B., & James, K.L. (2020). Predictors of Implementation in the Faith, Activity, and Nutrition Dissemination and Implementation Study: Application of the Consolidated Framework for Implementation Research (CFIR) in a Statewide Initiative. Translational Behavioral Medicine, Epub ahead of print. Article Abstract
Sharpe, P.A., Wilcox, S., Stucker, J., Kinnard, D., Bernhart, J., & James, K.L. (2020). Community Health Advisors' Characteristics and Behaviors, Role Performance, and Volunteer Satisfaction in a Church-Based Healthy Eating and Physical Activity Intervention. Journal of Community Health, 45(1), 88-97. Article Abstract
Bernhart, J.A., Dunn, C.G., Wilcox, S., Saunders, R.P., Sharpe, P.A., & Stucker, J. (2019). Church Leaders' Barriers and Facilitators Before and After Implementing a Physical Activity and Nutrition Intervention. Health Education Research, 34, (2), 188-199. Article Abstract
Saunders, R.P., Wilcox, S., Jake-Schoffman, D.E., Kinnard, D., Hutto, B., Forthofer, M., & Kaczynski, A.T. (2019). The Faith, Activity, and Nutrition (FAN) Dissemination and Implementation Study, Phase 1: Implementation Monitoring Methods and Results. Health Education & Behavior, 46(3), 388-397. Article Abstract
Wilcox, S., Saunders, R.P., Kaczynski, A.T., Forthofer, M., Sharpe, P.A., Goodwin, C., . . . & Hutto, B. (2018). Faith, Activity, and Nutrition Randomized Dissemination and Implementation Study: Countywide Adoption, Reach, and Effectiveness. American Journal of Preventive Medicine, 54(6), 776-785.
Sharpe, P.A., Wilcox, S., Kinnard, D., & Condrasky, M.D. (2018). Community Health Advisors' Participation in a Dissemination and Implementation Study of an Evidence-Based Physical Activity and Healthy Eating Program in a Faith-Based Setting. Journal of Community Health, 43(4), 694-704.
Wilcox, S., Parrott, A., Baruth, M., Laken, M., Condrasky, M., Saunders, R., . . . & Zimmerman, L. (2013). The Faith, Activity, and Nutrition Program: A Randomized Controlled Trial in African-American Churches. American Journal of Preventive Medicine, 44(2), 122-131.
In a 2019 barriers and facilitators study, most pastors and program coordinators perceived no barriers to putting FAN into place in their church. The most common barrier that was reported by pastors and program coordinators was that their congregation might be hesitant to change their eating and exercise habits and may not participate in programming. They also reported lack of motivation or interest among some members. These same groups found that strong leadership and both internal and external support through the church and program materials helped them overcome these perceived barriers. Additional barriers and facilitators are described in a paper based on this study.
Researchers recommend finding CHAs with the following characteristics or interests:
- Interest in promoting healthy eating and physical activity
- Experience working in church settings and/or training others
The study authors suggest creating a church committee with the following:
- Churchgoers passionate about health
- Churchgoers with health backgrounds
- Church cooks or those who make meal decisions
Other keys to success include:
- The strong support of the pastor or church leader
- Committee members who are passionate about health and have adequate time to follow through with activities
- Church leaders who believe in the importance of a health ministry
- Churches that recognize and reward the efforts of the church coordinator
You can download FAN materials by completing a brief form. You can complete an interest form for the online church committee training.
Black or African American
Community and faith-based initiatives
Wellness, health promotion, and disease prevention
May 22, 2018
Date updated or reviewed
June 9, 2020
Suggested citation: Rural Health Information Hub, 2020. Faith, Activity, and Nutrition [online]. Rural Health Information Hub. Available at: https://www.ruralhealthinfo.org/project-examples/1011 [Accessed 3 December 2020]
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