An Interview with Cheryl Holt —Working with Local Churches May Increase Screening Rates

Cheryl Holt, PhD
Social Psychologist, Associate Professor of Public and Community Health
University of Maryland

Dr. Cheryl Holt recognized the need to increase early detection rates for Colorectal Cancer within the African American community after reading multiple studies indicating that African Americans suffer a disproportionate burden of incidence and mortality from the disease. While acknowledging that the rate of incidence is likely to be multifactorial, she had no doubt that the disparity in early detection contributes to the mortality disparity.

PCC: In your study, in which you aimed to increase screening rates, you selected church settings as the location for the ‘interventions,’ -- Why?

Dr. Holt: We realized that within the black community, the most trusted source of information is the church, so we developed and evaluated a ‘spiritually themed health intervention.’

PCC: How did the study work?

Dr. Holt: We identified 16 churches and provided varying levels of assistance to promote colorectal screening. Initially, health experts trained two individual members of each church to be community health advisors (CHA). The CHAs then led sessions with their peers in which they taught about the importance of screening. We saw that discussions about the participants’ health were best received when the message was delivered by peers from their own community. We also offered monitoring and evaluation support as well.

PCC: Were there any interesting success stories as a result of the study?

Dr. Holt: As a matter of fact, one of our community health advisors who had just received his training said, ‘I guess I should walk the walk if I’m going to talk the talk.’ He underwent a screening colonoscopy and found that he did indeed have colorectal cancer. It was very lucky that he had found the polyp at an early stage and he became a living example of the importance of screening.

PCC: Typically the number one ‘patient activation’ is the doctor recommendation for a colonoscopy, but it sounds as though your study has found that peers and churches can be a powerful tool in increasing screening rates.

Dr. Holt: Peer-based health education in a church setting is ‘culturally appropriate’ because churches are already recognized as a social network for African Americans. The setting also can allow information to be framed in a spiritual way that emphasizes already accepted church principles regarding body, mind and spirit, or the notion of being healthy in a holistic way.