Purpose: Faith-based interventions are community-based approaches that recognize the central role the church plays in African-American communities. Pastors potentially exert an important influence on health behavior, serving as role models, disseminators of health information, and gatekeepers for health promotion programs, including those aimed at cancer prevention and control. This study explores pastors' perceptions and motivations related to being change agents in their churches and communities.

Methods: In-depth interviews were conducted with 30 African-American pastors in 2010-2011 using a semi-structured guide. Pastors were asked about their perspectives on influence in relation to their congregation and community. Questions focused on perceptions of their influence as well as how they have been influenced by their congregations, communities, and other roles (i.e., being bi-vocational, as a family member). Interviews were audio-recorded and transcribed verbatim. Data were analyzed using a combination of theory-guided and grounded theory approaches.

Results: Participants ranged in age, gender, and religious denomination. While our question asked about influence in general, many pastors' spoke about the health needs of their community as a motivating force, we have great disparity where sickness and disease is concerned. It is important that we use the church to reach people. Within this context of health, two themes emerged and add to our understanding of pastors as influencers of health behavior change. Organizational change theory recognizes the role leadership plays in the implementation of programs and pastors have been noted as the producers of culture within their churches. In our study, pastors acknowledged this influence and spoke of it as a responsibility. Pastors spoke of acting on this responsibility by promoting programs or outreach efforts to meet the needs and “improve the quality of life” (i.e., spiritual, physical, emotional, and financial) of their congregations and communities. They also spoke of the traits and characteristics a pastor requires to be influential. Some spoke of being a “facilitator” to the ideas and wants of their congregation/community, others spoke of being leaders and the motivating force behind initiatives, and still others used the term pioneer and felt they were most influential in helping create a vision or developing new ways for their congregation/community to address health issues. While discussing their influence, pastors spoke about congregation and community synonymously, with the community considered just a larger congregation. Pastors also felt their ability to be influential was modified by their religious denomination and ethnicity. They spoke of denominations with less structure providing more opportunities for pastors to be influential at a local level. In addition, pastors felt their ability to be influential was sometimes limited due to a lack of resources, which they felt was not as important an issue for White pastors and pastors with more affluent and urban congregations.

Conclusion: Our findings provide insight into developing effective faith-based interventions. They add to the current theories on pastors as change agents indicating pastors see themselves as important figures and want to foster a culture of holistic health within their churches and communities. However, collaborations between churches and researchers must acknowledge individual differences in pastors' perspectives on their role as behavior change agents and gatekeepers of African-American communities. To be successful, these efforts must take into account each pastor's strengths as well as their vision for themselves and their role in their congregation and community. Pastors' dedication to holistic, congregation-based health improvement holds great promise for reducing health disparities.

Citation Format: Paige Pirkey, Brook E. Harmon, Emma Draluck, Christine E. Blake, James R. Hebert. African American pastors' perspectives on their role in addressing health disparities. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A30.