摘要：Objectives. We examined the published literature on health programs in faith-based organizations to determine the effectiveness of these programs. Methods. We conducted a systematic literature review of articles describing faith-based health activities. Articles (n = 386) were screened for eligibility (n = 105), whether a faith-based health program was described (n = 53), and whether program effects were reported (28). Results. Most programs focused on primary prevention (50.9%), general health maintenance (25.5%), cardiovascular health (20.7%), or cancer (18.9%). Significant effects reported included reductions in cholesterol and blood pressure levels, weight, and disease symptoms and increases in the use of mammography and breast self-examination. Conclusions. Faith-based programs can improve health outcomes. Means are needed for increasing the frequency with which such programs are evaluated and the results of these evaluations are disseminated. There is a sizable multidisciplinary literature describing the health-related activities of religious or faith-based organizations (FBOs). Studies have described the features of successful health promotion programs and partnerships in churches 1, 2 and the importance of the church as an ally in efforts to provide preventive health and social services to at-risk populations. 3 In addition, the interconnections between public health, health education, and FBOs have been examined, 4 and the possible contributions of FBOs to improved community health outcomes have been described. 5 A development related to health programs offered by FBOs is the need for improving access to care for the 43 million nonelderly uninsured adults residing in the United States. It has been shown that uninsured individuals are more likely than those with insurance coverage to avoid seeking needed care, to have been hospitalized for a preventable condition, and to have been diagnosed with advanced-stage cancer. 6 Proposals for expanding health insurance coverage focus on increasing the role of government 7 and generally ignore the role played by nonfunded health care providers in providing access to care. Especially important for public health practitioners is whether faith-based health programs can, for example, provide predictable and measurable health benefits in the communities they serve. 8 FBOs have a long history of independently and collaboratively 9 hosting health promotion programs in areas such as health education, 1, 10 screening for and management of high blood pressure 11 and diabetes, 12 weight loss 13 and smoking cessation, 14 cancer prevention and awareness, 15– 17 geriatric care, 18 nutritional guidance, 19 and mental health care. 20 However, little is known about the effectiveness of these programs. Nonfunded health programs are not part of an organized system of care and are sometimes considered “nonsystems of care.” 21 However, if such programs provide consistent access to specific types of care for specific individuals, they may actually be delivering predictable—but unmeasured—community health benefits. A study was undertaken to review the health programs in FBOs and to examine their effectiveness. The Working Group on Human Needs and Faith-Based and Community Initiatives notes that the current vocabulary surrounding discussions of “faith-based” organizations tends to “confuse and divide.” 22 The term FBO evokes images ranging from store-front churches, to the YMCA, to the local chapter of Habitat for Humanity. In the present article, the term FBO is used as a catch-all category referring to health programs designed, conducted, or supported by groups affiliated with or based in a nonsecular setting. The National Congregations Study revealed that about 57% of US congregations participate in various social service delivery programs, including food and clothing, housing and homelessness, domestic violence, substance abuse, employment, and health programs. 23 In the present study, we examined the health activities of FBOs only or those activities specifically related to health promotion/disease prevention. Also, we examined the published literature on FBO health programs in an attempt to ascertain the effectiveness of these programs. Successful programs are likely to be overrepresented in such a review, which is consistent with our study intent: we were not concerned with presenting an exhaustive review of social service activities in FBOs; rather, we intended this study as a first step in determining the possible contribution of health programs to maintaining or improving the health of individuals in the communities they serve.
