Abstract
BACKGROUND: There is a high burden of chronic diseases such as hypertension and diabetes in small island developing states (SIDS). SIDS governments have committed to a range of public health measures to reduce this burden including community-based health education in collaboration with civil society organizations. We sought to explore church leaders' perceived acceptability, appropriateness, and feasibility of implementing self-management health programs in 20 faith-based organizations in the small island developing state of Barbados. METHODS: This was a concurrent nested mixed methods study - a quantitative online survey and a qualitative inquiry using semi-structured interviews. Acceptability, appropriateness and feasibility of the intervention were assessed using the following quantitative assessment tools: Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM) and Feasibility of Intervention Measure (FIM). Thirteen semi-structured interviews were conducted virtually, recorded and transcribed verbatim. Transcripts were analyzed using thematic analysis based on deductive codes from Proctor's implementation outcomes definitions. RESULTS: From the 52 respondents of the survey, the median and interquartile ranges for the AIM, IAM and FIM scales were 16 (15-20), 16 (16-20) and 16 (15-17) (out of 20), respectively. We found high levels of acceptability, 82% (95% CI (69%, 95%)) of leaders indicating that health programs in churches met with their approval; and high levels of appropriateness- 90% (95% CI (80%, 100%)) indicating health programs in churches were "fitting" and "a good match". In interviews, leaders expressed acceptance of healthy lifestyle programs and described their appropriateness through alignment with church doctrines stating, "the body is the temple of God". Feasibility scores were low, only 60% (95% CI (44%, 76%)) indicated that health programs in churches would be easy to use. Leaders felt that the high cost of nutritious food and restricted finances exacerbated by COVID-19 were likely to be barriers to program success. They felt unprepared to address health-related topics and expressed the need for support from healthcare providers who are sensitive and respectful of church culture. CONCLUSION: We found that health-based programs in churches align well with church doctrines, but the success of these programs will depend on, equipping leaders with the skills and knowledge to engage in health-related conversations while including biblically sensitive messaging.