Peer Support Dyads in a Health Promotion Program in African American Churches
Phase: NA
Conditions: Peer Support and Chronic Disease, Obesity, Type II Diabetes, Cardiovascular Disease, Cancer
Sponsor: Duke University

 
 
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July 8, 2020 
Cherie Conley 
Clinical Trials Final Report – Study Protocol and SAP 
Unique Protocol ID: Pro00091547 
Brief Title: 
Peer Support Dyads in Churches   
Official Title: 
Peer Support Dyads in a Health 
Promotion Program in African 
American Churches   
Secondary IDs: 
1F31NR017813-01    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
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4. Feasibility of a Dyadic Peer Support Intervention to Promote 
Healthy Weight in Three African American Faith Communities 
4.1 Introduction 
Cardiovascular disease, cancer, stroke and diabetes are the most common chronic 
conditions in the United States. Sixty percent of all adults in the United States have at 
least one chronic condition and forty percent have at least two (National Center for 
Chronic Disease Prevention and Health Promotion, 2019). Obesity is linked to multiple 
chronic diseases and prevalence has climbed sharply in the last decades (Budd & 
Peterson, 2014; Samuel-Hodge et al., 2009). This rise is especially pronounced for 
African Americans and has created a disproportionate burden of obesity-related chronic 
diseases (Office of Minority Health, 2019). By age 55, 76% of African American adults 
are diagnosed with high blood pressure compared to 55% of White males and 40% of 
White women (Thomas et al., 2018). In 2017, African American adults were 1.6 times 
more likely to be diagnosed with diabetes than White Americans and twice as likely to 
die from it (Diabetes and African Americans, 2019).  
Health disparities are preventable disproportionate burdens of disease shared by 
members of socially or economically disadvantaged populations or communities. 
Federally funded research as well as national and state health policies have aimed to 
address these disparities (Office of Disease Prevention and Health Promotion, 2020). 
Despite efforts to implement various health promotion and disease prevention programs, 
disparities persist (Caiola, 2015). There is a need for new and effective solutions. The use 
of peer support and specifically peer support dyads, has been recommended as a feasible 

 
 
3 
and effective health promotion strategy within African American populations (Wolfe, 
2004). The purpose of this pilot study was to determine the feasibility of using dyadic 
peer support to augment an existing healthy weight promotion program in three African 
American churches. 
4.2 Background 
4.2.1 Peer Support 
4.2.1.1 Benefits of Dyadic Support in Health Promotion  
Dyadic peer support is when two people who have the same goals or health 
condition work together to achieve health goals (Leahey & Wing, 2012). Dyadic support 
is also referred to as peer-to-peer support (Heisler, 2007), reciprocal support (Friedman, 
Niznik, Bolden, & Yee, 2016) or mutual peer support (Travis et al., 2010). Utilizing 
dyadic support has potential benefits. Dyads may allow for more sustainable changes 
because they can extend the care received in group classes or with health professionals, 
and offer a chance for partners to reinforce each other’s skills and knowledge (Travis et 
al., 2010). Dyads may have similar experiences or backgrounds and can help with 
problem solving, and be available more often to lend encouragement for health 
promoting behaviors (Black, Gleser, & Kooyers, 1990).  
Dyadic peer support has been used successfully in health promotion studies. An 
early study by Wing and Jeffery (1999) examining friend dyads illustrated that when 
participants were recruited for a weight loss program with a friend, participants lost more 
weight and were better able to maintain weight loss after ten months. Heisler and Piette 
(2005) used dyadic peer support to improve diabetes management. Participants were 
matched by gender, disease severity, or zip code, and were assigned to call each other 
once a week for six weeks. Participants reported better diabetes management. Ninety 

 
 
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percent of them stated that they wished their health care providers had a peer support 
program. Over 70% of participants stated that their partner helped them improve 
behaviors like making healthier food choices. Participants found dyadic support 
enjoyable and helpful, especially when acute situations arose and they needed someone to 
talk to; or when they wanted to talk about any personal issues in private, as opposed to a 
group setting. Leahey and Wing (2012) compared dyadic peer support from a mutual peer 
support partner, to dyadic peer support from a peer health coach or professional 
healthcare provider. Fifty percent of mutual peer support dyads were able to achieve 
clinically significant weight loss after a six month intervention. Importantly, this study 
also showed that pairing people with a peer led to almost as much weight loss as being 
coached by a professional healthcare provider.  
4.2.2 Faith Communities and Health 
It is recommended that to best address health inequities, initiatives are needed that 
promote health where people live, work, play and pray (Institute of Medicine, 2003; 
Office of Disease Prevention and Health Promotion, 2020). For African Americans, 
especially older adults living in the southern United States, churches are very influential 
community institutions (Catanzaro, Meador, Koenig, Kuchibhatla, & Clipp, 2007). 
Churches can reach large segments of a community consistently, provide space to host 
community programs, and provide access to leaders who can promote participation and 
help sustain programs (Hardison-Moody & Stallings, 2012; Lancaster, Carter-Edwards, 
Grilo, Shen, & Schoenthaler, 2014). Social support from one’s religious community, over 
and above general support, can be especially helpful for adopting healthier lifestyles 
(Krause, 2016), coping with illness (Holt, Clark, Debnam, & Roth, 2014),  maintaining 

 
 
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better mental health, and preventing substance abuse (Mason, Schmidt, & Mennis, 2012; 
Michael, Farquhar, Wiggins, & Green, 2008; Sanchez et al., 2019) 
Though African American faith communities are popular settings for health 
promotion programs, researchers note significant challenges in implementing and 
sustaining these programs (Campbell et al., 2007; Lancaster et al., 2014). First, there may 
be an overreliance on lay leaders to implement and maintain health promotion programs. 
The lay leader model of community interventions was introduced to encourage shared 
ownership of programs between organizations introducing the program and the faith 
communities (Eng & Hatch, 1991) hosting them. Often, however, lay leaders have 
multiple roles in their church and can become overwhelmed with additional duties 
supporting the program (Campbell et al., 2007; Lancaster et al., 2014). Second, without 
ongoing technical support, expertise, and resources from outside organizations, it is 
difficult for faith communities to implement fully or sustain the programs (Gittner, 
Hassanein, & Murphy, 2007; Tussing-Humphreys, Thomson, & Onufrak, 2015; Yanek, 
Becker, Moy, Gittelsohn, & Koffman, 2001). As a result of these challenges, the 
architects of Body & Soul, a popular and widely used obesity prevention program 
supported by the National Cancer Institute, stressed the need for more immediate 
research to determine how best to implement church-based health programs (Allicock et 
al., 2013). 
4.2.3 Theoretical Basis 
   This study is guided by the Transactive Goal Dynamics Model (TGDM) and the 
Socioecological Model (SEM). The TGDM builds on existing theories of goal setting and 
social support among dyads (e.g. interdependence theory)(Johnson, 2003; Lewis et al., 

 
 
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2006). When individuals become part of a dyad, interpersonal processes become a salient 
driver of goal setting and attainment (Johnson, 2003; Lewis et al., 2006). The TGDM 
identifies two main constructs (TGDCs), 1) dyad interaction frequency, and 2) goal 
coordination, that describe cooperation within dyadic relationships which facilitate goal 
attainment (See Figure 6). Dyad 
interaction frequency is driven by 
three factors: shared dyadic goal(s), 
strong motivation to achieve the 
goal(s), and opportunities to work 
together to achieve the goal(s). Goal 
coordination is determined by two 
factors: whether dyad members agree 
on how they are to achieve their shared 
goal(s), and how well they assist each other in overcoming obstacles and utilizing 
available resources. Dyads are most likely to achieve their goals when interaction 
frequency is high and when goal coordination, which serves as a mediator, is also strong. 
While this study does not test the model, TGDM constructs, dyad interaction frequency 
and goal coordination, were used to design content for the dyad training session and to 
guide development and analysis of dyad cooperation in semi structured interviews. 
The Socioecological Model (SEM) illustrates that health is affected by 
intrapersonal, interpersonal, community, organizational and policy level spheres of 
influence (Bronfenbrenner, 1977; McLeroy, Bibeau, Steckler, & Glanz, 1988). Policy 
level factors create social, environmental, and economic conditions that promote or limit 
opportunities for health in communities and organizations. These conditions in turn affect 
Figure 6. Modified Transactive Goal 
Dynamics Model 
Socioecological 
Model (SEM) 

 
 
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intrapersonal processes and individual health behaviors. The intrapersonal processes and 
health behaviors include goals that dyads select, strategies they choose to overcome 
challenges, and the opportunities they have to interact. Therefore, concepts of the SEM 
are integrated into the modified TGDM to account for broader social factors that may 
affect participants’ ability to work together and achieve their health goals.  
4.3 Aims 
This prospective multi method study explores the feasibility of using dyadic peer 
support to augment an existing state-wide healthy weight promotion program in three 
African American churches in North Carolina. The study aims are to: 
Aim 1: Assess feasibility, via survey, logs, attendance, and interview data, of a dyadic 
peer support intervention to augment an existing program to promote fruit and vegetable 
intake (FVI), physical activity (PA), and healthy weight.  
Aim 2: Assess goal attainment and health outcomes through biometric measurements (i.e. 
changes in body mass index (BMI), blood pressure, and weight), survey data (i.e. FVI, 
PA), and semi structured interviews (participant perceptions of goal attainment and social 
or environmental factors that influenced their ability to achieve better health).  
Aim 3: Assess and describe dyad cooperation using semi-structured interviews, guided by 
the Transactive Goal Dynamics Model (TGDM) (Fitzsimons, Finkel, & vanDellen, 
2015); Specific constructs are 1) dyad interaction frequency - how dyads develop team 
goals, interact with and motivate each other to achieve those goals, and 2) goal 
coordination - how dyads discuss challenges to attaining their health goals and strategies 
used to overcome them. 

 
 
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4.4 Methods 
4.4.1 Design Overview   
This was a prospective multi-method 18-week feasibility study to explore using 
peer support dyads to augment an existing healthy weight promotion program, Faithful 
Families Thriving Communities (Faithful Families), in African American churches in 
North Carolina. The intervention included nine weeks of group health education classes, 
followed by nine weeks of dyads working together to achieve their health goals (Table 6). 
For the first nine weeks, participants attended weekly 90-minute group health education 
classes at their faith community. At the end of the nine weeks, each participant selected 
or was assigned a peer support partner. After attending one 90-minute dyadic training 
session, dyads worked together for the second nine weeks to improve fruit and vegetable 
consumption, physical activity, and other health goals they identified. The group 
reconvened twice during the second nine weeks to share progress. Before starting the 
program, all participants were consented in a private area of the church. The Duke 
University Institutional Review Board approved the study.    
4.4.2 Intervention 
4.4.2.1 The Existing Faithful Families Thriving Communities Program  
Faithful Families Thriving Communities (FF) is a practice tested healthy weight 
and lifestyle promotion curriculum developed through a partnership with the North 
Carolina Department of Health and North Carolina State University (Hardison-Moody & 
Yao, 2019). The program consists of nine weekly health education classes delivered at 
the faith community by a North Carolina Cooperative Extension nutrition educator 
(referred to as “nutrition educators” going forward). Church lay leaders co-lead the 
program with nutrition educators by adapting elements of the curriculum to the needs of 

 
 
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their community and integrating spiritual elements such as a song or scripture. Classes 
focus on nutrition and physical activity (e.g. Choosing More Fruits and Vegetables, 
Making Smart Drink Choices, Choosing To Move More Throughout The Day). Each 
session involves a Powerpoint© lecture, group discussion questions, a physical fitness 
activity, and cooking demonstrations or tastings. ‘Faithful Families Thriving 
Communities’ is based on the Socioecological Model of health and therefore encourages 
faith community changes at the policy, interpersonal, and intrapersonal levels as well 
(Hardison-Moody & Yao, 2019). Faithful Families Thriving Communities has been 
implemented in faith communities across the state of North Carolina for the past 12 years 
(Hardison-Moody et al., 2011) . Program evaluations show communities enjoy the 
program and want to continue to improve health after it ends. Thus, a peer support 
component was designed to augment the existing program and allow faith communities to 
continue to improve their health by building capacity within the organization for 
members to support one another. 
 
 
 
 
 
 
 
 
 
  

 
 
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Table 6. 18 Week Dyadic Peer Support Program Outline 
 
Weeks 1-9:  
Health Education 
Classes 
Weeks 10-18: 
Dyadic Peer Support 
‘Choosing More Fruits 
and Vegetables’ 
‘Plan Know What’s for 
Dinner’ 
‘Shop for Value, Check 
the Facts’ 
‘Shop: Get the Best for 
Less’ 
‘Fix it Fast, Eat at 
Home’ 
‘Fix it Safe’ 
‘Making Smart Drink 
Choices’ 
‘Choosing to Move 
More’ 
‘Making the 
Connection' 
Week 10: 
Dyad Peer Support  
Training Session 
Week 14: 
Group 
Meeting 
Week 18: 
Group 
Meeting  
 
 
Community and 
Individual Assets 
 
 
Team Goal Setting 
Shared Motivation 
Shared Challenges 
Shared Strategies 
 
 
Supportive 
Communication 
Progress 
Challenges 
Strategies 
End of 
Program 
Weekly Health Education Newsletters 
Note: SEM = Social Ecological Model, CET = Community Empowerment Theory, TGDM = 
Transactive Goal Dynamics Model  
 
 
4.4.2.2 The New Dyadic Peer Support Component 
The dyadic peer support component included one dyad peer support training 
session, dyads working together on their goals for nine weeks, and two group sessions 
during the nine weeks. Participants also received weekly newsletters. The purpose of 
using dyadic peer support to augment an existing health promotion program was twofold. 
First, evaluations from past Faithful Families Thriving Communities programs showed 
participants want additional health promotion programming once the standard FF 
curriculum is complete. Second, using existing networks and resources to promote health 
TGDM, 
Behavior 
Change 
Literature 
SEM,  
CET 
Peer 
Support 
Literature 

 
 
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increases the possibility of successful program implementation and behavior change 
(Aschbrenner et al., 2016; Eng & Hatch, 1991; Leahey, LaRose, Fava, & Wing, 2011). 
Existing resources in this program were faith communities (i.e. relationships among 
members, available goods and services) and the longstanding relationship between the 
North Carolina Cooperative Extension offices and the faith communities. At the end of 
the first nine weeks, participants either chose or were assigned a partner if they did not 
have a preference. Partners were assigned by the lay leaders and PI based on any 
relationship they had prior to the program, or developed during the classes – evidenced 
by repeatedly choosing to sit next to one another and talking during classes.  
Dyads first attended a 90 minute dyadic peer support training session delivered by 
the PI. Session topics were 1) setting team goals, with an emphasis on increasing fruit 
and vegetable intake and physical activity; 2) ways to cooperate with your partner to 
achieve your goals (e.g., motivation, interaction, supportive communication); 3) potential 
challenges and solutions to improving health (including asset identification); and 4) 
expected dyad activities for the next nine weeks (communicate with partner, track 
progress on logs). During the training, dyads were provided work sheets and asked to 
choose one nutrition and one physical activity SMART (specific, measurable, achievable, 
realistic, timely) goal (Hooker, Punjabi, Justesen, Boyle, & Sherman, 2018) to work on 
together.  The recommended guidelines for daily fruit and vegetable consumption (at 
least seven servings per day) (American Heart Association, 2017b; Moore et al., 2015) 
and minutes of physical activity (150 minutes of moderate activity) (American Heart 
Association, 2018) were reviewed and dyads were encouraged to incorporate both into 
their goals. Participants also developed individual goals if they had unique health 
concerns. During the session, scenarios were presented that illustrated common 

 
 
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challenges to achieving health goals. Dyads were asked to discuss their own potential 
challenges. Solutions to challenges were presented and discussed in the group and among 
dyads. Participants identified personal, church level, and community assets that might 
help them achieve goals (Whiting, Kendall, & Wills, 2012) and overcome challenges. 
Partners were encouraged to discuss their motivations for wanting to achieve their health 
goals and how to keep each other motivated. Participants also learned effective 
supportive communication techniques.  
Topics were based on the TGDM, SEM, Community Empowerment Theory 
(CET), behavior change literature (Hooker et al., 2018)and dyadic peer support literature 
(Cherrington et al., 2015; Gorin, Powers, Koestner, Wing, & Raynor, 2014; Kowitt et al., 
2017). Training on shared goals, motivation, frequent interaction, and shared strategies to 
overcome challenges was based on constructs the TGDM identified are important for 
successful dyad cooperation (Fitzsimons et al., 2015). Formative research (Chapter three) 
reflected African American church members’ desire to work with another to improve 
health and identified the need for partners to have specific goals and be motivated to be 
successful. These results corroborate the theoretical foundation of the training. Also, 
dyads identified their own community and personal assets.  Health is influenced by 
multiple spheres of personal, social and community factors. Communities and community 
members have resources and assets that when identified can be shared among community 
members (in this case dyads, specifically) and used to improve health (McLeroy et al., 
1988; Saleebey, 1996; Smith & Liehr, 2008).  
Peer support studies distinguish different types of communication and how they 
can affect outcomes. Directive communication is instructive, and may be perceived as 
controlling, even if encouraging (Kowitt et al., 2017). Autonomy supporting, non-

 
 
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directive communication acknowledges and enhances an individual’s confidence in their 
own personal choices and motivations, avoiding exerting pressure or control as a way to 
motivate (Cherrington et al., 2015; Gorin et al., 2014). While both may be useful (e.g. 
using directive when someone has no idea of how to perform a basic task and needs 
specific direction; using autonomy supporting when a partner is making a renewed effort 
to carry out their plan), goal achievement tends to increase with autonomy supporting 
communication (Gorin et al., 2014; Leahey & Wing, 2012). Thus, during the training, 
participants discussed how to ask about and provide support for plans and actions their 
partners identified (Peers for Progress, n.d.).  
Formative research (Chapter three) and results from other weight loss and peer 
support studies show that participants perform better and prefer structured supervision 
(MaineGeneral Health, 2004).Thus, rather than leaving dyads on their on their own for 
eight weeks without any contact, the PI reconvened the groups after four weeks to share 
progress and challenges. To assist in goal attainment, participants were given a log sheet 
to help monitor (Hooker et al., 2018) their progress; they wrote the number of servings of 
fruit and vegetable consumed each day, minutes of daily physical activity, and number of 
weekly communications with their partner.  
4.4.3 Participants and Setting 
The inclusion criteria for churches were faith communities with predominantly 
African American members in one of three counties served by Expanded Food and 
Nutrition Education Program (EFNEP) nutrition educators. Participant criteria were 
adults ages 18 years and older who identify as African American; reported being church 
members or regular church goers; speak, read and write English; willing to complete 

 
 
14 
study activities and assessments; and able to engage in moderate physical activity. (e.g., 
walking – based on their own activity level and assessment).  
This feasibility study captured qualitative and quantitative data. Data from 
qualitative interviews generally reaches information saturation between 10-15 interviews 
(Guest, Bunce, & Johnson, 2006). Thus, a sample size of 20 dyads or 40 participants was 
planned to ensure data saturation and account for an attrition rate of 30%, as found in a 
meta-analysis of weight loss programs (Lemstra, Bird, Nwankwo, Rogers, & Moraros, 
2016). Also, because statistical significance is not the aim of this feasibility study, a 
sample size of 40 was considered sufficient to allow insights into patterns of change for 
quantitative outcomes such as weight and physical activity (Leahey & Wing, 2012; 
O'Brien et al., 2015). Due to great interest, 80 members across the three sites (site one – 
18 members, site two – 24 members, site three – 38 members) were enrolled.     
4.4.4 Procedures 
Three county nutrition educators were recruited to participate. Before starting 
recruitment, the PI, program director and county nutrition educators met to review the 
program purpose, timeline and how to integrate intervention activities. Each nutrition 
educator works in one county. After meeting with the PI and reviewing the program, 
nutrition educators began recruiting churches in their counties via word of mouth, online 
searches, and face-to-face visits. Faith communities were recruited from May-November 
of 2018. A search of African-American faith communities and faith community-affiliated 
organizations was conducted via online searches, neighborhood canvassing, and word of 
mouth. Faith communities and faith community-affiliated organizations were contacted 

 
 
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via email, their Facebook sites, phone, community organization board meetings, or face-
to-face visits.  
Initial contact of churches was made by the PI or county nutrition educators. A 
total of 62 churches were approached. Contact was made with 36 to introduce the 
program and provide contact information to schedule a follow-up meeting if interested. 
Of the seven churches that expressed interest, three were ready to begin immediately and 
selected to start the program. No additional churches were selected because it was 
anticipated that the first three would be able to recruit the desired sample size of 40 
participants. After agreeing to participate, lay leaders, educators, the faith community 
pastor and the PI helped to recruit church members through church announcements 
describing the program and flyers. 
4.5 Measures 
4.5.1 Participant Characteristics  
At baseline, participants completed a survey assessing age, level of education and 
sex.  
4.5.2 Program Feasibility (Aim 1)  
Feasibility was assessed in three domains: 1) church and participant recruitment 
and retention - based on number of churches contacted that agreed to participate, and 
participant attendance at each class during the 18-week program; 2) nutrition educators’ 
perceptions of feasibility – based on post intervention semi-structured interviews, and 3) 
participants’ perceptions of feasibility – based on how many times per week they 
communicated with their partner, post intervention semi-structured interviews, and a nine 
item feasibility survey. The nine items were adapted from a 21 item feasibility survey 

 
 
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from a dyadic diabetes management program (Heisler & Piette, 2005). Survey items 
specific to diabetes management such as blood testing or medications were omitted. 
Questions for this dyadic study included: ‘My peer support partner helped me do things 
to improve my eating habits’, ‘I would work with my peer support partner again’, and ‘I 
helped my partner achieve their goals’. The survey consists of 5-point Likert items from 
1=strongly disagree to 5=strongly agree. Cronbach’s alpha of 0.87 showed good internal 
consistency of the feasibility scale in this study.   
Post-intervention semi-structured interviews were completed with a random 
sample of seven dyads from each church and the nutrition educator assigned to each 
church. Participants who completed the interview received a $25 gift card. Participant 
feasibility questions included in the interview were: ‘What was your overall experience 
like working with a partner?’, ‘What made it easier or harder to work with a partner to 
achieve your health goals?’. Nutrition educator questions included in the interview were, 
‘What were some of the barriers and facilitators of using dyads?’, ‘What aspects of this 
intervention would you keep, or change and why?’. 
4.5.3 Goal Attainment and Health Outcomes (Aim 2)  
Weight, blood pressure, and BMI were measured at weeks 1, 9, 14, and 18 by the 
PI in a private area in the church. Blood pressure was taken using an Omron electronic 
cuff or Welch Allen manual blood pressure cuff if measures could not be obtained 
electronically, after participants were seated for three to five minutes. Systolic or diastolic 
pressures greater than 130 or 80 were considered high,120-129 and 70-79 elevated, and 
less than 120 or 70 normal (American Heart Association, 2017a). Floor scales were used 
to measure weight. Height was self-reported for BMI calculations. BMI is a standard 

 
 
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measure of obesity based on an individual’s weight in proportion to their height. Values 
greater than 29 kg/m2 are considered obese, 25-29 kg/m2 is overweight and 18.5-24.9 
kg/m2 is the normal range (American Heart Association, 2014).  
Fruit and vegetable intake and physical activity were measured at weeks 1, 9, and 
18 using survey items developed by the United States Department of Agriculture (USDA) 
Expanded Food and Nutrition Education Program (EFNEP) survey (Bradford, Serrano, 
Cox, & Lambur, 2010; National Institute of Food and Agriculture, 2018). Dietary intake 
is measured in two different ways. One is a 24 hour food recall which asks participants to 
write down all foods consumed in the past 24 hours, resulting in a summary of the 
number of vegetables and fruits eaten during that time period. The other question asks for 
the number of servings of fruits and of vegetables that participants think they eat each 
day, on average.  These items are part of the entry and exit surveys normally completed 
by Faithful Families Thriving Communities participants and thus have been used 
successfully among African American churchgoers (Hardison-Moody et al., 2011). 
Cronbach’s alpha of 0.6 at baseline, 0.7 at week nine, 0.6 at week 18, and 0.8 between all 
three time points showed acceptable internal consistency of the survey items used in this 
study. Finally, in semi structured interviews, participants were asked if any other social or 
environmental variables, such as access to food or places to exercise, influenced their 
ability to achieve their health goals. 
4.5.4 Dyad Cooperation (Aim 3)  
Semi-structured interviews were used to obtain an in-depth understanding of how 
dyads cooperated to set, pursue, and attain their goals. Prompts were guided by the two 
main TGDM constructs – interaction frequency, which includes, opportunities to interact, 

 
 
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mutual motivation, and shared goals, and goal coordination, which includes discussing 
challenges and coming up with strategies. Examples of prompts include ‘What were your 
team’s goals?’, ‘How did you and your partner motivate one another?’, and ‘Tell me 
about strategies you used to achieve your goals?’.  
4.6 Analysis 
Table 7 outlines the timeline and analysis methods for each aim.  
4.6.1 Participant Characteristics  
Participant characteristics obtained at baseline were analyzed using descriptive 
statistics (e.g., means, standard deviations). T-tests were used to identify any differences 
between participants who completed the program and those who did not. ANOVA and 
fisher’s exact statistical tests were used to identify any significant differences in baseline 
characteristics between participants at the different church locations.  
4.6.2 Program Feasibility (Aim 1)  
Feasibility survey item scores were averaged to provide a total score. The 
frequency of choosing ‘agree’ or ‘strongly agree’ was also calculated for each item. Dyad 
communication frequency was tallied from participant logs. A multilevel model 
(participants nested in dyads) was used to determine what, if any, characteristics (i.e., 
partner choice, type of partner relationship, education, age, sex, church) predicted higher 
feasibility scores and dyad communication frequency.  
4.6.3 Goal Attainment Health Outcomes (Aim 2)  
Unconditional means models were run for each outcome and the intraclass 
correlation was calculated to assess for dyad dependence. A three-level mixed model 
(participants nested within dyads over time) was used to assess changes in weight, BMI, 

 
 
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systolic blood pressure, fruit and vegetable intake, and physical activity. Both unadjusted 
and adjusted models were run. Church site, dyad relationship (i.e., friend, family or 
acquaintance), dyad assignment (whether dyads chose or were assigned their partner), 
and participant characteristics (age, sex, education) were added as model covariates. 
Dependence of participants during the second nine weeks was accounted for by creating a 
dichotomous variable to separate measurements taken before participants were paired and 
measurements taken after they were paired.  
First, significant changes from baseline to 18 weeks were assessed. Second, 
significant changes during the first nine weeks before participants were paired, compared 
to the second nine weeks after they were paired, were assessed. Third, three interaction 
terms were entered into three different models to assess whether or not dyad relationship 
type, dyad partner assignment, or dyad communication frequency influenced changes in 
health outcomes while participants were paired. Additional descriptive statistics were 
generated to assess the proportion of participants who were able to achieve clinically 
significant weight loss (weight loss >=5% of body weight) (Leahey, Kumar, Weinberg, & 
Wing, 2012; West, Coulon, Monroe, & Wilson, 2016) as well as the recommended 
servings of fruits and vegetables and daily minutes of physical activity.  
4.6.4 Dyadic Cooperation (Aim 3)  
Directed content analysis (Hsieh & Shannon, 2005) was used to analyze semi 
structured interviews. Deductive a priori coding guided by the TGDM was used to 
analyze dyad cooperation. Inductive coding was used to analyze participant’s perceptions 
of program feasibility, and the influence of social and environmental factors that 
influenced their health. Transcripts were read and re-read to identify and  
 

 
 
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assign codes. Codes were grouped according to themes. Ten percent of transcripts were 
read by a second reviewer to compare codes, resolve discrepancies in coding, and 
interpret results.   
 
Table 7. Assessment Variables and Timeline 
Aim 
Variable 
Week 
Assessed 
Analysis 
Method 
Participant 
Characteristics 
 
Participant characteristics 
 
1(Baseline) 
Descriptive 
statistics 
Participant 
Characteristics 
Baseline differences between 
church sites 
 
1 
ANOVA, 
Fisher’s exact 
Participant 
Characteristics 
Baseline differences between 
those who did and did not 
complete the program 
 
1 
T-test 
Feasibility 
Church and participant 
recruitment and retention 
1-18 
Descriptive 
statistics 
Feasibility 
Feasibility Survey Scores, 
Dyad communication 
frequency 
 
18 
Descriptive 
statistics 
Goal 
Attainment/Health 
Outcomes 
 
Changes in FVI and PA and 
interactions 
1, 9, 18 
Mixed Model 
 
Goal 
Attainment/Health 
Outcomes 
 
Changes in SBP, BMI, weight 
and interactions 
 
1, 9, 14, 18 
Mixed Model 
Feasibility;  
Goal Attainment; 
Dyad Interactions  
Perceptions of feasibility, 
dyad interactions - challenges 
and strategies 
18 
Directed 
Content 
Analysis 
 
 
 

 
 
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Allicock, M., Johnson, L. S., Leone, L., Carr, C., Walsh, J., Ni, A., . . . Campbell, M. (2013). 
Promoting fruit and vegetable consumption among members of black churches, 
Michigan and North Carolina, 2008-2010. Preventing Chronic Disease, 10, E33. 
doi:10.5888/pcd10.120161 
American Heart Association. (2014). Body mass index in adults. Retrieved from 
https://www.heart.org/en/healthy-living/healthy-eating/losing-weight/bmi-in-adults 
American Heart Association. (2017a). The facts about high blood pressure. Retrieved from 
https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-
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