Evaluation of a Faith-Based Stress Management Program “<em>Trinity Life Management</em>” In a Rural African-American Community

Research Article

Ann Nurs Res Pract. 2016; 1(2): 1009.

Evaluation of a Faith-Based Stress Management Program “Trinity Life Management” In a Rural African-American Community

Bryant K*, Haynes T and Willis N

Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, USA

*Corresponding author: Keneshia Bryant, Associate Professor, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot #820, Little Rock, Arkansas 72205, USA

Received: August 23, 2016; Accepted: October 20, 2016; Published: October 21, 2016


The Trinity Life Management: A Faith-Based Stress Management intervention was developed by an academic research team in partnership with a rural African-American faith community following the principles of community based participatory research. The purpose of this collaboratively designed intervention is to provide parishioners the techniques and tools they need to effectively cope with stress and minor depression symptoms. This can be done by enhancing their knowledge of the stress-distress-depression continuum, increasing their ability to distinguish between stress and depression, and strengthen their self-efficacy in performing coping behaviors. The intervention is co-led by lay health leaders, Trinity Leaders. The purpose of this feasibility pilot study was to test the protocols, procedures, and processes of the study; track recruitment, retention, and attrition; monitor the fidelity of the intervention; and obtain Trinity Leader and participant evaluations of the study experience. There were a total of 20 participants. The study results suggested that additional leader training would be needed to address beliefs about the causes of depression and stigma. Also, in an effort to reinforce the intervention delivery process and maintain consistency, there should be incorporation of standardized scripts for the lay leaders. In addition, further role plays and practice sessions are needed to enhance facilitation skills. Finally, changes in the recruitment of participants and the inclusion criteria to identify those most in need of the intervention.

Keywords: Stress; Faith; Rural; African-American; Community based participatory research


Although stress can be useful in certain situations, chronic stress is related to cardiovascular disease, metabolic syndrome, obesity, emotional overeating, and depression [1-6]. This is especially concerning for African- Americans living in rural areas because they are exposed to high levels of chronic life stress related both to their rural residency and their race/ethnicity. Not only can stress have detrimental effects on one’s physical health, but also negatively impacts one’s mental health. Ethnic groups that tend to experience high rates of stress, such as African-Americans, tend to report high levels of psychological distress, which is often a risk factor for the development of psychiatric disorders [7,8]. Life stressors of rural African-Americans put this population at particular risk for depression and other health related issues [7]. In addition to stress, lack of social support and inadequate coping processes has been linked to risk of depression [9,10]. In a recent report, persons 45- 64 years of age, African-Americans, persons with less than a high school education, individuals unable to work or unemployed, and persons without health insurance coverage were more likely to meet the criteria of depression [10]. Given the negative impacts of stress on both mental and physical health, it is important to support stress self-management among rural African-Americans, not only for those who manifest a disease or disorder, but also for healthy people. A holistic approach to stress self-management that incorporates ones faith may prove to be an effective means of mental health promotion.


Faith has been shown to aid in more effective handling of stressful events [11-13].This is particularly true among African-Americans, who give great importance to spirituality including the use of prayer and faith to cope with stress [14-18]. Additionally, African-Americans tend to seek support from their community, neighborhood, and family when faced with stress. The church, as one of the most trusted institutions in rural African-American communities, often serves as a venue for receipt of social support and information, making churches an ideal setting for stress management programs. Churches are available in nearly every community and because of their mission of service and caring for others; they have served as the site of a variety of health promotion programs [19-21]. A majority (59%) of African- American faith communities attend historically Black denominational traditions, which include the National Baptist Convention, Methodist, and Pentecostal churches. Approximately 7,500 religious congregations exist in Arkansas, of which about 10% are characterized as historically Black denominational traditions [14]. This estimate is higher than the national average. Informal church-based networks can help make mental health promotion programs successful [22,23] and they can be of particular advantage in rural, lower socioeconomic communities. Yet, very few interventions addressing stress issues have been developed and tested in the African-American community [24,25]. And there are no evidence-based depression prevention interventions targeting the rural African-American faith community [26]. Therefore, the Trinity Life Management: A Faith-Based Stress Management Intervention was developed using a Community Based Participatory (CBPR) approach. This paper discusses the evaluative process of a feasibility pilot study.

Trinity Life Management: A Faith-Based Stress Management Intervention

Trinity Life Management is a 6-week, gender-specific group intervention designed to promote stress self-management based on the theory of self-efficacy and on social network theory [27,28]. The intervention addresses the stress-distress-depression (impairment) continuum [29-31] and provides parishioners the self-management tools and techniques they need to effectively cope with stress. The goals are to 1) enhance participants’ knowledge of the stressdistress- depression continuum including risk factors, symptoms and consequences; 2) increase participants’ ability to distinguish between experiences of stress and depression; and 3) strengthen participants’ coping self-efficacy in performing stress self-management when faced with life challenges. In addition, participants acquire tools to achieve effective communication and self-reflection.

Trinity Life Management is co-led by lay health leaders, called Trinity Leaders. All weekly sessions of the intervention follow a similar format: open with a welcome and prayer requests, followed by a prayer, a review of the prior week’s lesson (during the first week an overview of the program is given), the current week’s lesson(s), and a closing prayer. Each of the weekly sessions lasts approximately 90 minutes. All session topics are included in the participant notebooks (Table 1). The notebooks also include local and regional social and health resources in the appendix. The intervention teaches participants a variety of stress self-management techniques, goal-setting, and evaluation to individualize strategies to cope with stress. The specific details regarding the development process of the intervention was published elsewhere [32,33].