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 34th in health outcomes out of 46 counties. Ranking factors include adult obesity (39% of Fairfield County adults are considered obese, compared to a statewide average of 32%) and poor access to exercise opportunities (23% of the county population has access to places for physical activity, compared to a statewide average of 54%).
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; 59.1% 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 Community Coordinating Council. 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.
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 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 (currently in progress) is implementing FAN statewide in one denomination's churches.
FAN is indexed in the National Cancer Institute's Research-Tested Intervention Programs (RTIPs), based on its 2013 study.
For more detailed information on program results:
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, Epub ahead of print. Article abstract
Saunders, R.P., Wilcox, S., Jake-Schoffman, D.E., Kinnard, D., Hutto, B., Forthofer, M., & Kaczynski, A.T. (2018). The Faith, Activity, and Nutrition (FAN) Dissemination and Implementation Study, Phase 1: Implementation Monitoring Methods and Results. Health Education & Behavior, Epub ahead of print. 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. Article Abstract
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. Article Abstract
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
You can download FAN materials by completing a brief form.
Community and faith-based initiatives
Wellness, health promotion, and disease prevention
May 22, 2018
Date updated or reviewed
May 22, 2019
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.