‘The WORD’: A step of faith in preventing diabetes in underserved communities

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By Keely Brewer
Mississippi Center for Investigative Reporting

Dr. Karen Yeary brought The WORD to churches in the Arkansas Delta.

The former professor at the University of Arkansas for Medical Sciences decided to introduce a lifestyle intervention plan through places of worship — The Wholeness, Oneness, Righteousness, Deliverance, a faith-based weight loss intervention to stem the ravages of diabetes.

“This all really started from my own personal experience being a pastor’s kid,” Yeary said. “Being a pastor’s kid, I just saw how powerful the church was as a social institution in terms of influencing the behavior of its members.”

The WORD translates the National Diabetes Prevention Program into a culturally relevant model for Black adults of faith in rural areas. The program National DPP was developed in 2010 and promotes lifestyle changes to reduce risk for Type 2 diabetes.

Karen Yeary was a professor in the Health Behavior and Health Education Department at the University of Arkansas Medical Sciences when she brought The WORD, a cultural derivative version of the National Diabetes Prevention Program to rural Black churches. She is now professor of oncology at Roswell Comprehensive Cancer Center in Buffalo, N.Y. University of Arkansas Medical Sciences

“Before the Diabetes Prevention Program, people basically thought — and this is being very generalistic — but they basically thought the only way to prevent diabetes was through medicine,” Yeary said. “And what the Diabetes Prevention Program did was it created a lifestyle intervention focused on healthy eating and exercise to prevent diabetes.”

Yeary said national programs didn’t resonate with Black diabetes patients. The National DPP was a landmark study, but it consistently has worse outcomes for participants of color.

The American Association of Clinical Endocrinologists affirmed this in a 2019 position statement, saying cultural adaptation is a necessary component of optimal diabetes care.

“For each ethno-cultural population, health messaging and diabetes care will need to consider issues of potential distrust of health care professionals, history of discrimination, reigious practices, food preferences, attitudes toward physical activity, and despite the full range of socio-economics, the impact of poverty on engagement, self-monitoring, adherence with lifestyle and medical reccomendations, and recruitment for clinical trials,” the association said.

Yeary partially blames the disparity on a history of structural inequality in healthcare and medical mistrust. The ripple effects of that have left pockets of the population suffering disproportionately from health disparities.

Dr. Bala Simon is the deputy chief medical officer at the Arkansas Department of Health and the state chronic disease director.

“Diabetes is heavily related to nutrition, particularly highly calorific processed foods, and those happen to be cheaper,” Simon said. “And people of lower socioeconomic status tend to gravitate because of the limited financial resources they have.”

To combat these disparities, Yeary delivered the program in 31 churches and used the preexisting strength of the community to her advantage. When she set out to understand the health needs of the community, she was directed to Pastor Jerome Turner.

At the time, Turner was working at the Boys, Girls, Adults Community Development Center in Marvell, Arkansas, an organization that aims to improve the overall quality of life for mostly Black residents through affordable housing, accessible health care and recreational facilities.

Karen K. Yeary, second from right, and Pastor Jerome Turner, far right, worked to implement Yeary’s faith-based approach to diabetes prevention in Phillips County, in the Arkansas Delta. Pictured with them are other members of the Phillips County Task Force are Pastor Johnny Smith, left, and Tiffany HaynesI. Arkansas Public Health Association

Some of Yeary’s colleagues at the University of Arkansas for Medical Sciences recommended Turner as a connection in the local faith community. They connected, and Turner became the community coordinator and community researcher for The WORD trial.

Together, they assembled the Faith Task Force, a coalition of local stakeholders who were concerned about their community’s health. They developed and conducted surveys to better understand the health needs of the Phillips County area. Several health issues were mainstays in the survey responses, and diabetes was one of them.

With the intent to reach the community through faith-based organizations, the survey responses informed their decision to develop a culturally relevant adaptation of the National DPP.

“We started off thinking about health concerns for the community,” Turner said. “It wasn’t that we started off with all African-American churches … It just ended up being that once we did the pilot work, the focus became on some issues that are high in the African-American community.”

Yeary and her team worked with church leaders who recommended at least two church members to be trained as interventionists. A typical session began with two interventionists present. The key, Yeary said, is that the program leaders were already part of the community.

Each session included a weigh-in followed by a 45-minute educational intervention. The next 10 minutes were devoted to Bible study, and the session closed with a half hour of group exercise.

Dr. Pearl McElfish is vice chancellor at the University of Arkansas for Medical Sciences. Her research shows that excess weight is considered the strongest modifiable risk factor for type 2 diabetes, and a 5% to 10% decrease in weight can have clinically meaningful outcomes.

Northwest Arkansas has the highest population of Marshallese outside of the Marshall Islands.

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“Thousands of Marshallese have left their island homelands for a variety of reasons: employment and educational opportunities, access to healthcare, the lingering effects of radiation due to nuclear testing, the evident consequences of sea level rise, and simply to join their families in the United States,” the Marshallese Education Initiative said.

The prevalence of Type 2 diabetes in the Marshallese hovers around 40% — about four times the national average. The source of this disparity is unclear, but McElfish blames it on underrepresentation of Pacific Islander populations in national diabetes research.

McElfish is expanding research to combat disease in the Marshallese community. Her three-year program, which ended in 2020 DATE YEAR, was funded with a $2.1 million research grant. Since 2014, the UAMS Northwest Regional Campus has received more than $10 million to reduce health disparities in both Marshallese and Hispanic residents — including a grant from the Walmart Foundation, which is headquartered in neighboring Benton County.

Dr. Pearl McElfish, vice chancellor of the University of Arkansas for Medical Sciences University of Arkansas Medical Sciences

Forty-five participants from Arkansas churches in rural Carroll and Madison counties participated in McElfish’s program, which was adapted from The WORD.

McElfish and her team introduced a culturally relevant adaptation of the National DPP to the Marshallese community, and the program was administered through churches. This tactic made sense, as more than 96% of Marshallese in the area report regular church attendance.

Other minority groups also report higher rates of religious beliefs than their white counterparts. More than 80% of Black Americans report a religious affiliation compared to 75% of white Americans. Like the Marshallese, Black Americans also face worse health outcomes than white Americans.

The Arkansas Department of Health’s Office of Faith-Based Outreach was created in 2016, and its budget has since doubled.

“Faith leaders have trusted messengers within their communities and are on the front lines of fighting many of the health issues that are affecting our communities,” the Office of Faith-Based Outreach said.

Yeary and McElfish shared similar goals: Reach underserved populations through faith communities while making national diabetes prevention programs culturally relevant.

“We were on the cutting edge of research, but no one really knew it,” Turner said.

Yeary conducted one of the few studies on the costs of implementing weight loss interventions in the context of a randomized controlled trial. The total implementation costs for The WORD were $340.95 per participant, or $63 per pound lost.

Her research is one of the few comprehensive examinations of costs for a National DPP translation for Black adults of faith. Practitioners and policy makers can use Yeary’s research to determine the engagement of churches and disseminate the adaptation in faith-based settings.

The WORD trial has ended, but they’ve applied for another grant. The first go-around was focused on taking the National DPP and making it culturally relevant for Black communities of faith. The next round, if approved, will focus on a cost-effective way of training interventionists and sustaining that intervention.

“We’re developing these programs to see whether or not this program will work in our community,” Turner said. “And if it works in our community, can we also get this program to work in other communities?”

The next round, if the grant is approved, will be focused on training interventionists in a cost effective way and disseminating the intervention in a sustainable way.

This story was produced by the Mississippi Center for Investigative Reporting and funded in part by the Fund for Investigative Journalism. It was also produced in partnership with the Community Foundation for Mississippi’s local news collaborative, which is independently funded in part by Microsoft Corp. The collaborative includes MCIR, the Clarion Ledger, the Jackson Advocate, Jackson State University, Mississippi Public Broadcasting and Mississippi Today.

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