Dissemination of Couples' Interventions Among African American Populations: Experiences from ProSAAM

In this article, we discuss general observations about successful delivery of culturally sensitive variations of empirically grounded strategies for relationship enhancement and divorce prevention. This discussion focuses on the importance of religious traditions in culturally sensitive marriage enrichment services. In particular, we highlight our ongoing investigation of the Program for Strong African American Marriages (ProSAAM) and share some of our experiences in disseminating ProSAAM to communities in northeast Georgia. As intervention providerscontinue to explore ways to enhancetheir programs , a direct focus on dissemination issues is of critical importance. Clearly, access to prevention programs and marital therapydiffer across regions of the country and among ethnic groups (Stanley, Amato, Johnson, & Markman, in Press). Dissemination is particularly important for African Americans, who are under-served by typical means of health care delivery. Rural African American families tend to be skeptical of the benefits to be derived from mental health services; therefore, they are not likely toexaminedadvocate for these services in their communities (Brody, Flor, & Stoneman, 1996; Murry & Brody, 2004). Reasons for this reluctance include mistrust of medical researchers, contextual factors such as a lack of transportation or means to pay for services, and culturally irrelevant programs (Murry, Kotchick, et al., 2004). African Americans also have the highest therapy dropout rate of all ethnic groups ( Sue, Zane, & Young, 1994). For these reasons, establishing trust and offering programs that take into consideration the racial, socioeconomic, and regional characteristics of the populations they serve are critical to effective program delivery. Among African American couples, religiosity and church involvement predict relationship quality (Brody & Flor, 1996; Taylor et al., 1999), suggesting that this population is more likely to respond favorably to relationship enhancement programs if those programs encourage couples to draw upon their religious practices. Historically, religious participation has been an important survival strategy for African Americans. During enslavement, a strong religious orientation served as a framework for preserving family values and overcoming staggering experiences of injustice in a dehumanizing environment. This legacy of spirituality and religious involvement has been passed down through generations, remaining a consistent part of the fabric of African American culture over time, location, and context (Taylor, Chatters, & Levin, 2004). For many African Americans, cultivating a relationship with God remains the ultimate source of inspiration and guidance (McAdoo, 1983; Taylor & Chatters, 1991). For this reason, religiosity plays a significant role in predicting family outcomesin African American populations. Several key research concepts helped us to incorporate religious elements intoa culturally sensitive interventiondesigned to minimize the effects of discriminationon African American couples. First, we noted the link between prayer and dealing with adversities such as health problems (Dunn & Horgas, 2000; Ellison, 1998). Second, we the growing body of research on religious forms of coping and the potential for religiously based coping to facilitate adjustment and well-being (Ellison, 1991) and to reduce depression (Williams, Larson, Buckler, Heckman, & Pyle, 1991). Third, we reviewed studies that integrated religious practice with standard practices in psychotherapy (Tan, 1987) and marriage enrichment (Stanley et al., 2001). Finally, because experiences with discrimination are emotionally disruptive to African Americans (Murry et al., 2001), we focused on materials that explicitly help spouses support one another in responding to discrimination. Our incorporation of religious material and prayer into ProSAAM was one means of creating a culturally sensitive vehicle for relationship enhancement that would be familiar and appealing to the participants while keeping the program consistent with established intervention guidelines. In addition, emphasizing programs that really work and that have a strong skill-based component is a good way to connect with African American communities. We