Journal of Christian Nursing:
Feature: parish nursing/research
Health Report for U.S. Seminary Schools: Are We Training Healthy Clergy?
Bopp, Melissa; Baruth, Meghan
Melissa Bopp, PhD, RN, is an assistant professor of Kinesiology at Pennsylvania State University. Her research includes developing culturally and spiritually tailored interventions. She writes about the role of clergy in health promotion and how they contribute to the health environment of churches.
Meghan Baruth, PhD, RN, is a research associate at the University of South Carolina. She is involved in various health promotion interventions, including a large scale faith-based intervention targeting environmental change in African Methodist Episcopal churches.
The authors declare no conflict of interest.
Accepted by peer review 8/7/2013.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article at journalofchristiannursing.com
ABSTRACT: Seminary schools are responsible for training clergy members and clergy have been shown to influence the health environment of faith-based organizations. The purpose of this study was to document the health environment at seminaries in the United States. Study results provide insight into the health-related environment of seminary schools influencing the next generation of clergy members.
THE CLERGY-HEALTH CONNECTION
In the United States, faith-based organizations (FBOs) represented by roughly 335,000 religious congregations are trusted social institutions with nationwide reach (Hartford Institute for Religion Research, 2012), serving as a strong community partner for effective health promotion (Bopp, Baruth, Peterson, & Webb, 2013; Bopp & Fallon, 2011; Campbell, et al., 2007). Approximately 40% of Americans attend worship services once a week or more, with higher representation among many underserved communities (Gallup Wellbeing, 2010; Pew Research Center, 2008). Across the country, worship-going individuals are served by about 600,000 clergy (Hartford Institute for Religion Research, 2012). For health interventions to succeed in faith settings, health promotion professionals agree on the importance of clergy involvement, participation, and endorsement (Bokinskie & Kloster, 2008; Campbell, et al., 2007).
Organizational theories have noted the importance of buy-in and support from the organizational leader, supporting their importance in health promotion interventions (Butterfos, Kegler, & Francisco, 2008). A national survey found that healthier clergy report more health and wellness resources in their FBO. Clergy education on health also was a significant influence on available resources for health within FBOs, highlighting a previously overlooked avenue for reaching this influential group (Bopp & Fallon, 2011). This study, along with other research (Bopp et al., 2013) has noted the link between clergy education and health and the health environment of FBOs—which has the potential to influence the health of congregation members.
Community health nurses and faith community/parish nurses have a history of reaching others through FBOs (American Nurses Association & Health Ministries Association, 2012). Health promotion efforts in FBOs involve cooperation between the nurse, clergy member(s), and the congregation. Having clergy that are more supportive of health-related matters has the potential to result in greater support and resource allocation for programming and activities. The knowledge, beliefs, and experiences of clergy with health promotion are important for nurses to consider when designing programs for congregations, and clergy members' own health should not be overlooked.
Seminary schools enroll approximately 74,500 students annually (Association of Theological Schools [ATS], n.d.). Limited research suggests that clergy perceive minimal instruction in seminary regarding health-related issues for promoting self-care (Bopp, Webb, & Baruth, 2012). Studies have noted negative health outcomes and poor health behaviors associated with a clerical career (Bopp et al., 2013). Providing education about healthy habits and illness prevention could be an effective strategy for reducing morbidities and mortality in future clergy, as well as providing a basis for improving the health-related environments of FBOs. The purpose of this study was to examine the health-related resources, programs, and policies currently in place at seminaries in the United States.
ASSESSING HEALTH RESOURCES AT SEMINARIES
Following approval by the Institutional Review Board at Pennsylvania State University, the Association of Theological Schools (ATS) 2007 fact book on seminary education was used to identify schools for a cross-sectional, mixed methods study. The ATS listed 220 schools in the United States that conducted post-bachelor professional and academic degree programs to educate persons for the practice of ministry, teaching, and research in the theological disciplines (ATS, 2007). School Web sites were searched for contact information for a person who would be knowledgeable of health-related activities and overall philosophy of the school toward health (e.g., deans, curriculum advisors, admissions personnel). All 220 schools were contacted via email explaining the purpose and content of the study, and told we would follow up in 3 to 5 days with an email invitation to take the survey. Recipients were asked to respond with the names and emails of other individuals within their institution if they felt someone else was more knowledgeable to respond to the survey.
Approximately 3 to 5 days after the initial contact email, the same contacts were sent an email invitation with a URL link to take the survey; a reminder email was sent 1 week later. Initially 56 school contacts responded online, 9 declined participation, and 12 emails were returned as undeliverable. School contacts that did not decline the email invite and did not respond (n = 143) were sent a paper version of the survey along with the contact letter describing the study and a postage-paid return envelope (4 undeliverable, n = 10 responded). Of the total online and paper survey responses (n = 66; 30% response rate), 9 were discarded for incomplete data (less than 1/3 of the survey completed), thus the final sample size was 57. Respondents included deans (n = 14, 25%), admissions personnel or registrar (n = 8, 14%), student services personnel (n = 7, 12%), and other (n = 28, 49%).
Respondents were asked (open-ended question) about the general denomination of their school. Denominations included general mainline Christian/non-denominational (n = 9), Lutheran of any kind (n = 5), Baptist of any kind (n = 4), Catholic (n = 4), Episcopal (n = 3), and other (n = 32). Respondents indicated the total enrollment of seminary students, types of degrees/certificates offered (the majority offered master's degrees), and the location of the school (majority were in large or moderately sized urban areas, n = 27). The number of full-time, part-time, adjunct faculty, and staff were reported. Schools were dichotomized on enrollment as small (1–99 students; n = 22) and large (100+ students; n = 35). Respondents reported the percentage of the student population that was female (mean % = 41.6), racial/ethnic make-up of the student body (non-Hispanic White was most common), percentage of full-time students (mean % = 56.5), and what percentage took classes online only (mean % = 9.2).
LIMITED HEALTH RESOURCES
A total of 57 seminary school contacts completed the survey, representing 26% of the 220 seminaries in the United States. Respondents indicated (yes/no) whether specific health resources were available for seminary students (i.e., health-clinic, exercise facility, counseling center, intramural sports, etc.). The number of resources per school was summed (mean = 2.59, SD 1.68). Respondents also reported on policies regarding smoking (not permitted on campus, n = 25) and food choices in vending machines (only four schools had policies). The number of bike parking spots, transit-stops serving campus, and most frequent mode of travel to campus for students were reported. The activity-friendliness of the campus was assessed with a 5-item Likert scale where respondents indicated their degree of agreement with four items about the neighborhood of the seminary school (sidewalks, bike lanes, crime, traffic) (Sallis et al., 2009). The items were summed to create an activity-friendly neighborhood score where higher scores indicate more activity-friendly environment (range 4–20, mean = 15.29, SD 2.77). Data for all descriptive statistics and health-related resources and programming at the schools can be found online as supplemental digital content at http://links.lww.com/NCF-JCN/A30.
T-tests and chi-square analyses compared the differences in health environments at large and small schools. Larger seminaries were more likely to report a physical activity/exercise center on campus (χ2 = 10.73, df = 1, p = 0.001) and reported more health and wellness resources (t = 2.32, p = 0.02) compared with smaller schools. Smaller schools stricter noted smoking policies and were more likely to report smoking was not permitted on campus (χ2 = 7.00, df = 2, p = 0.03). Larger schools were more likely to offer more bike parking (χ2 = 10.28, df = 4, p = 0.03).
There were a number of limitations to this study. First was the low response rate and sampling method. The process of selecting the appropriate seminary school contacts and determining which administrators would be both knowledgeable and receptive to survey participation was difficult. Although we contacted all of the schools from the 2007 ATS list, we have no way of knowing if our sample is representative of all theology schools or if we had greater response from schools or administrators that have a greater interest in health. Future studies may consider targeting only the highest level of administrators for gathering information about the schools and using other strategies for collecting data (e.g., structured interviews). Second, we were limited with the self-report measures for data collection, presenting challenges with validity and reliability. Also, the administrator who responded may not have been knowledgeable about items listed in the survey. Structured health-environment audits by trained technicians may be an approach to address some of these challenges. However, the geographically dispersed sample is a barrier to conducting interviews.
RECOMMENDATIONS FOR ACTION
These findings shed light on a previously unstudied institution that serves future clergy. Previously researchers have indicated that clergy tend to experience negative health outcomes (Bopp et al., 2013) and clergy health has been linked to the health-related resources at FBOs (Bopp & Fallon, 2011). Health-related resources at FBOs have the potential to impact community health. Findings of the current study suggest there is a relative lack of health promotion resources available to seminary students. In addition to the limited offerings addressing health, environmental and policy supports for health also were relatively minimal (smoking, vending machine policies). Schools were most likely to offer exercise/physical activity facilities for students, although this resource was not found as often on smaller campuses.
Active travel to campus has been found to be relatively common on traditional campuses (Bopp, Kaczynski, & Wittman, 2011; Kaczynski, Bopp, & Wittman, 2012) and can be a method of accumulating daily physical activity, although in the current study driving was the predominant method of travel. Seminary school campuses could make changes to their physical environment and work toward becoming more bike-friendly following national standards (The League of American Bicyclists, 2013). Intervention strategies could encourage active travel to campus by providing additional bike parking, creating awareness campaigns regarding the benefits of active travel, or developing social norms and support for active travel through groups or teams of students or faculty/staff.
Although there was limited reporting of vending machine policies in these seminary schools (n = 4), policies for healthy foods have been implemented in K-12 schools with limited documented success (Fletcher, Frisvold, & Tefft, 2010; Han-Markey et al., 2012; Park, Sappenfield, Huang, Sherry, & Bensyl, 2010). A few studies have shown improved food choices with healthy vending options (Knol, Pritchett, & Dunkin, 2010; Phillips, Ryan, & Raczynski, 2011). Simple intervention studies could include changing the content of the vending machines or enacting policies to include healthy foods.
To consider a similar model, the training of physicians in medical schools has shown significant negative health outcomes associated with the process of medical school education (Frank, Smith, & Fitzmaurice, 2005; Shanafelt et al., 2005). However, physicians engaging in regular wellness practices have improved physical and mental well-being (Firth-Cozens, 2001; Gross, Mead, Ford, & Klag, 2000). The Vanderbilt Medical Student Wellness Program Model instills healthy habits and a focus on self-care that is essential for academic success as well as addressing future occupational stresses (Drolet & Rodgers, 2010). The down-stream implications of improving medical student health and behaviors are noteworthy as researchers have found that physicians engaging in a healthy behavior (e.g., exercise) are more likely to counsel for that behavior among their patients (Lobelo, Duperly, & Frank, 2009). A model focused on establishing healthy behaviors in preparation for a stressful occupation could easily be translated to a seminary school. Parish nursing programs, although often focused on the congregation, could be expanded to address the health risks associated with ministry occupations or to work with clergy to role model the healthy behaviors that parish nursing programs target.
Nursing schools could consider partnering with seminaries to build skills and awareness for health-related issues among future clergy members and to lay a foundation for partnering with healthcare professionals to target health promotion. Collaboration between nursing and seminary schools could result in a greater understanding for nurses aiming to serve in faith communities and clergy who have a greater appreciation for the possible contribution of nurses to the well-being of their congregations. Parish or community nursing education programs could offer continuing education credits to provide the nursing community with a stronger background for working with clergy on health programs.
This study provides insight into the current health-related environment of seminary schools, which can influence the next generation of clergy members. With the potential for widespread reach throughout communities, FBO's can serve as another institution for offering health-affirming physical and social environments, concurrent with Healthy People 2020 goals (U.S. Department of Health and Human Services, 2012). Seminaries serve as an important venue for educating future faith leaders and should be recognized as an invaluable partner for intervention.
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clergy; community health; faith-based organizations (FBOs); health promotion; seminaries
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