Navigating conflicting community and academic beliefs in the development of a depression intervention for rural, faith-based, African American communities

OBJECTIVES: Some rural, African American, faith-based communities hold beliefs about depression that may be contrary to scientific evidence. We describe how our community-academic partnership addressed these potentially conflicting views in the context of developing a depression intervention for African American adults.

METHODS: In the context of a community-based health assessment in 30 churches (n=461) that identified depression as an issue to be addressed, our partnership designed a culturally appropriate, lay-led, evidence-based depression intervention. When developing the intervention, beliefs about depression that conflicted from a medical perspective arose, including depression’s origins (demonic, generational curse), depression’s definition (‘being crazy’), how individuals with depression were characterized (spiritual weakness), and recovery from depression (‘more faith in God’). Coming to a consensus about depression-related beliefs was essential in intervention development and delivery by lay leaders.  

RESULTS: The partnership decided to develop a more comprehensive conceptualization of depression that included both spiritual and physical factors (e.g. a generational curse can be transmitted through genetics, but can be overcome). Beliefs that could not co-exist with each other (e.g. depression as demonic possession vs. not) were respected and the team decided to acknowledge the spiritual and emphasize the physical. To ensure consistent intervention delivery by lay leaders that may hold conflicting beliefs, the team also developed a lay leader application assessing depression beliefs to engage lay leaders in a conversation about mental health.  

CONCLUSIONS: In participatory research, conflicting beliefs within a community-academic partnership are inevitable, but resolution is possible in the context of trusting and respectful relationships.