Spirituality, Self-management and Chronic Disease among Ethnic Groups of Robeson County, North Carolina (2016-2017)

Engagement in self-management skills—such as an effective approach to managing stress levels—has been demonstrated to improve health outcomes. What is less well known is the extent to which individual and community-based factors contribute to self-engagement.

Spirituality, which has been associated with positive effects on mental health including coping, resiliency and fostering social networks, plays an important role in effective improvement of chronic disease outcomes among minority populations.

Located in southeastern North Carolina, Robeson County has a diverse population of Lumbee Indians, African Americans, Caucasians and Hispanics. It is the poorest county in the state, and it ranks at the bottom in length of life, quality of life, health behaviors, social and economic factors and clinical care measures. Mortality rates are twice the state average for diabetes and cardiovascular disease, and the county’s rate of end-stage kidney disease is among the highest in the U.S.

This Bass Connections project team set out to assess the spiritual and self-management practices of adults living with chronic diseases in Robeson County and to determine differences in spiritual and religious practices across major ethnic groups living in the county. Team members formulated testable hypotheses and developed research plans. In Summer 2016, the team focused on assessing gaps, barriers and resources in the county with regard to chronic kidney disease and how these factors differ across ethnic and racial groups. Team members conducted quantitative and qualitative interviews with adults of all ages, with and without chronic kidney disease. Questions were related to positive mental health, coping, stress, neighborhood cohesion, self-efficacy, communication and health literacy. The team also conducted focus groups and tested participants for kidney disease.


Summer 2016 – Spring 2017

Team Outcomes

Laura Richman, Jay Pearson, Cherry Beasley, John Stanifer. “Addressing Health Inequalities in Diverse, Rural Communities: An Unmet Need.” 2019. SSM – Population Health

Spirituality, Coping, and Resilience Among Rural Residents Living with Chronic Kidney Disease (Tony V. Pham, Cherry M. Beasley, Jane P. Gagliardi, Harold G. Koenig, John W. Stanifer. 2019. Journal of Religion and Health 58(4):1-18)

Chronic Kidney Disease (CKD) and Information Gap (poster by Han Nguyen and Joyce En-Hua Wang)

This Team in the News

Witnessing Global Health in North Carolina

Our View: When It Comes to Taking Care of Patients, Tanzania and North Carolina Have a Lot in Common

John Stanifer: To Tanzania and Back

2017 Teaching Award Winners (Cherry Beasley)

Student Research Team Laying Groundwork for Improved Health in Robeson County, NC

Congratulations to the Student Leadership and Service Award Winners

From our work with the spiritual leaders we are gaining a better understanding of how people perceive disease and how it fits in with their worldview. This is critical for helping us understand how best to communicate information and what type of language is most effective when discussing kidney disease. –John Stanifer

See related summer program, Improving Outcomes for Chronic Kidney Disease in Southeastern North Carolina.

Additional support for this project was provided by the Silver Family Kenan Institute for Ethics Fund in Support of Bass Connections.

Team Leaders

  • David Boyd, Duke Global Health Institute
  • Clarissa Diamantidis, School of Medicine-Medicine: General Internal Medicine
  • John Stanifer, School of Medicine-Medicine: Nephrology

/graduate Team Members

  • Daphne Wang, Global Health - MSc

/undergraduate Team Members

  • Emily Horn, Public Policy Studies (AB), Global Health (AB2)
  • Christiana Oshotse, Public Policy Studies (AB)

/yfaculty/staff Team Members

  • David Toole, Divinity School

/zcommunity Team Members

  • Cherry Beasley, UNC Pembroke - Nursing*
  • Southeastern Regional Medical Center (SRMC)