Christian Relief, Development, and Advocacy 2(2), Winter 2021 Gross and Paltzer, Effects of a Virtual … 85 Effects of a Virtual Church-Based Wellness Circle Program in Chile During COVID-19 Elise Gross and Jason Paltzer The Christian non-profit Kingdom Workers began a wellness circle program in Linares, Chile, two months before COVID-19 restricted most in-person activities. This article describes why the program began, how it was intended to operate, and how the Kingdom Worker Chile (KW Chile) team adapted to continue the program virtually, while maintaining its core mission of partnering with Christians to share the gospel message through a health and wellness support program. The forced adaptation of the wellness circles to a virtual format contributed to an increase in the number of program participants from the community as well as from neighboring cities and countries. There was also an increase in the number of volunteers who were able to offer additional supplementary activities. While the wellness circle program is new and small, it is a valued non-profit ministry and lessons can be learned from analyzing its experiences during the pandemic. Overall, the positive effects of the program’s transition online have permanently altered its structure for the foreseeable future and KW Chile plans to continue offering virtual wellness circles to involve volunteers and participants whose engagement is no longer hindered by travel, location, or time restraints. Introduction The global COVID-19 pandemic brought many faith-based non-profit organizations either to a standstill or to the realization that their planned activities had to be drastically modified in order to continue operating under new government and health guidelines. While community health holds the utmost importance, especially during a pandemic, the administration and delivery of health programs in communities became an additional threat as traditional methods often rely on in- person interactions that could further the spread of COVID-19. As programs quickly confronted new realities, they were also faced with the degree to which changes should be implemented. Small faith-based organizations operate on minimal field budgets with small local teams. Decisions need to be made about making temporary quick fixes or permanent changes that would alter how programs operate. In a situation like the COVID-19 pandemic, field teams had to decide how to move forward with supporting existing health programs within an altered context. Kingdom Workers is categorized as a small- to medium-sized faith-based organization. Often, the experiences of such organizations are not represented in the dialogue of evidence-based strategies including those needed to respond to COVID-19. The purpose of this article is to share the experience of a local field team and the lessons learned transitioning from a traditional face-to-face wellness circle program to a virtual format, while maintaining a focus on authentic communication around faith and health. It is important to understand the situation and available resources of small faith-based organizations and the opportunities they have in being flexible and responsive to environmental changes and emergencies. Background The Chilean Ministry of Social and Family Development revealed in 2017 that 75% of adults and 51.58% of children in Chile are obese and that 66.2% of the population is inactive (Ministry of Health 2017). Chile is sixth among countries in the Organization for Economic Cooperation and Development (OECD) in the prevalence of diabetes in South America (Galaz 2017). According to the International Diabetes Foundation (Malanda et al. 2019), 9.8% of Chile’s adult population were diagnosed with diabetes. This does not include the number undiagnosed and those with pre- diabetes. Based on a community assessment survey conducted by KW Chile in 2019, people are generally aware of the risk of obesity and diabetes and value preventive care strategies, but do not apply the strategies Christian Relief, Development, and Advocacy 2(2), Winter 2021 Gross and Paltzer, Effects of a Virtual … 86 to their everyday lives. There is an overall high level of stress given the 44-hour work week, low wages, and transportation challenges that lead to even longer workdays with uncertain pay for those with contract work. This influences the eating and exercise habits of many Chileans. In addition, the culture of the Maule region where the wellness circle program is located places a high value on food and the sharing of traditional food such as many types of bread. Eating what is provided is a sign of respect and trust. These habits and conditions lead many to believe that they do not have control over their health. The Chilean government recognizes obesity and diabetes as nation-wide problems and has put into effect health campaigns in schools and in food packaging industries; unfortunately, Chilean individuals and families do not have easy access to general education regarding preventive care or support in making healthy habits a reality. Community health experts and Christian volunteer coaches of wellness circles can be a source of support and strength for those who desire or need a healthier life. Program Description The mission of Kingdom Workers is to advance the gospel by partnering with local churches and their communities to discover and overcome their greatest obstacles together. Kingdom Workers believes that God’s love is holistic, impacting a person’s life here and now, physically and spiritually, and that true and lasting healing is the result of gospel testimony interwoven with human care. Every Kingdom Workers program is founded on the following three principles: meaningful local relationships, Christian welfare, and gospel proclamation. A team composed of KW representatives, Lutheran church members, and community members completed a formal community assessment in Linares in 2019 resulting in the creation of KW Chile and the wellness circle program. This program centers on partnering with community leaders to coach small groups of people to achieve habit-change in nutrition and fitness in order to prevent chronic diseases such as obesity and diabetes. The theory of change utilized in the program is based on a social ecological model of change that focuses on the individual, family, and community supports such as the local church and healthcare experts (Bronfenbrenner 1994). The goal is to address issues related to social, family, and spiritual health because these domains are influential to the motivation not only to change behaviors around healthy eating and exercise but also to sustain those behaviors. In addition, the wellness circle program integrates biblical insights into every session, providing the motivation for behavior change based on Jesus’ love for his children and their desire to be good stewards of his blessings for them and their families. Individuals with a good faith-based support system in place can navigate prioritizing healthy preventive habits to counter negative behaviors (Grim & Grim 2019; VanderWeele 2017). Sharing Jesus’ love and redemption is at the center of every interaction at KW Chile. Figure 1 displays the structure of the program from KW Chile program staff, the local church and community partners, to individual Wellness Circles. KW Chile organizes volunteers from the local church and community to create a space for smaller wellness circles. The wellness circles are groups of individuals who agree to grow in their health and faith while holding each other accountable to small incremental behavioral change goals. Figure 1: KW Chile wellness circle structure The wellness circle program includes three areas, including preventive care community workshops, wellness circles, and volunteer coach training. Preventive care community workshops are led by local professional doctors, nurses, nutritionists, and counselors who share evidence-based preventive care strategies. These community workshops and seminars intend to close the health literacy gap in Linares and feed into opportunities for participants to join faith- based peer wellness circles based on geography, life phase, age, and gender. Wellness circles provide a space for participants to be a part of a trusted community that shares best practices, provides accountability, positive social pressure, and ongoing support. Wellness circles meet regularly in forms that best suit their members – in homes, KW offices, coffee shops, workspaces – and members stay in touch regularly through their team WhatsApp group. Each Wellness circle is led by a Christian volunteer (coach) who is a source of support and strength for individuals and families in their circle who are facing stressors that impact their health. In wellness circle sessions, coaches elicit behavior change conversation addressing barriers related to social pressure, culture, personal behaviors and beliefs, and the environment. Faith and the role of Jesus in the lives of the participants is integrated through KW Chile Local Church Wellness Circle Wellness Circle Community Partners Wellness Circle Christian Relief, Development, and Advocacy 2(2), Winter 2021 Gross and Paltzer, Effects of a Virtual … 87 the coaches in a way that emphasizes the God of grace in everyday living. KW Chile trains and assists Christian volunteer coaches to establish wellness circles by carrying out the following steps: 1. Increasing the awareness of the issue in the community through free, community-based health workshops. 2. Connecting interested volunteers with the KW Chile wellness circle coordinator who… a. Collaborates with community health experts using participatory strategies to create curricula. b. Trains volunteer coaches in facilitating small group discussions and behavior change theory. c. Provides ongoing support to volunteer coaches through seminars and additional training. Figure 2 shows the structure of the model following a socio-ecological framework. Each level incorporates individuals respective of their society: 1) Christian volunteers from the local church and community; 2) Individuals and families who desire knowledge and support in combating obesity and diabetes; 3) Community health experts. The diagram also demonstrates that trained volunteer coaches are the foundation of the program, because they are the ones who found and lead wellness circles. Preventive care workshops are supplementary resources that serve the community and allow KW Chile to invite members of the community to join wellness circles. Figure 2: KW Chile wellness circle program structure Program Structure The pilot wellness circle began in the city of Linares in January 2020. The pilot was projected to last 18 weeks, with the participants meeting weekly, either in-person or through WhatsApp communications. The circle was intentionally kept small since the ideal size for a wellness circle is between six-to-ten people in order to foster trust and authentic communication amongst its members. Participants were encouraged to attend monthly preventive care community workshops hosted by KW Chile. The main objectives of the pilot group were to: 1. Receive feedback on the wellness circle curriculum. 2. Gather data to determine participant growth in developing and implementing healthy habits to their everyday lives. 3. Encourage and recruit several participants to become volunteer coaches. The pilot wellness circle operated as planned for 1.5 months with an initial group of ten individuals. In early March, however, COVID-19 came to Chile and drastically altered the way of life. Since then and until the present-day (December 2020), schools have remained closed. The country remains under State of Emergency which includes nation-wide laws obligating all residents to wear masks in public areas and to respect curfew and gathering restrictions. Depending on statistics, communities fluctuate between lock-down quarantine and reentry protocols. Socially, many Chileans respect the COVID-19 restrictions and follow self-imposed quarantine measures for as long as possible. The arrival of COVID-19 to Chile forced the pilot wellness circle to pivot. KW Chile suspended its in- person activities following the lead of other community health, education, and faith groups. While communication within the pilot group was still maintained through WhatsApp, the team now had to figure out how to continue meeting together in a way that would continue to develop a supportive community and provide for authentic, faith-driven conversation. In addition, the program’s supplementary activities like group exercise opportunities, partnering with local health professionals, and community workshops could no longer take place as had been previously planned. Of the initial ten individuals in the pilot group, four dropped out due to COVID-19, scheduling conflicts, or a decision to not continue, resulting in a group of only six people completing the pilot program in the city of Linares. Adaptation Strategy During the program planning, the KW Chile team had never considered online elements as a part of the program apart from an informative social media presence. Chileans in the region where Linares is located greatly value relationships and quality time spent face-to-face. Because of this, all program activities were planned to be held in-person. Yet,COVID-19 ushered in a unique opportunity when Chileans continued to desire face-to-face time, but were physically restricted. While previously technology might have been viewed as a cold or unreal way to 3. Preventive Care Workshops 2. Wellness Circles 1. Volunteer Coach Training •Community health experts •Individuals/families who desire knowledge and support in combating obesity and diabetes •Christian volunteers from the local church •Christian volunteers from the community Christian Relief, Development, and Advocacy 2(2), Winter 2021 Gross and Paltzer, Effects of a Virtual … 88 gather in community, it suddenly became a blessing sought by many. Most Chileans in Linares have access to a web accessible cell phone or to a computer in their homes. Within a week, the KW Chile team decided to transition the pilot group to a virtual Zoom platform. Initially, the team used the free version of Zoom. With many phone calls, practices, and initial delays in starting due to participants learning the login process with audio and video, everyone finally got online for the first virtual session. While not all the planned content was delivered, participants were thrilled to see each other and to pray together as the unknowns of COVID-19 were heavy. After a couple sessions, participants were comfortable with the platform and were especially thankful to be able to continue meeting from the safety of their own homes. In fact, the most common comment written on each session’s exit survey was “We need to meet more!” Zoom suddenly made the idea of additional gatherings feasible in everyone’s schedules. As the weeks of restrictions continued, KW Chile bought a professional Zoom account and began to realize other opportunities that the platform brought. The team began meeting again with local healthcare professionals, collaborating, or presenting on the program and completing interviews through Zoom. A fitness instructor from Santiago, 3.5 hours away from Linares, began volunteering with the program by leading modified workouts through Zoom for interested wellness circle participants. In addition to Zoom, the program’s Facebook page became essential. Community healthcare partners volunteered to create short preventive care videos. The videos not only increased the online audience, but also the number of potential community partnerships. A health clinic in a neighboring city reached out desiring to learn more about the program in order implement a wellness circle in their area. A restaurant with healthy food delivery options shared recipes and cooking tips through KW Chile. Additional healthcare professionals contacted KW Chile to see how they could volunteer. Facebook is widely accessible and easy to stream. Because of this, in-person community workshops became Facebook Live sessions. Together with healthcare professionals, staff members crafted sessions that pushed audience members to interact with the messages being shared. As adaptations ushered in more opportunities, KW Chile remained focused on maintaining their mission of building meaningful local relationships, proclaiming the gospel, and serving the needs of the community related to preventive care. Partnering with the local church and Christians remained of primary importance. Those who expressed the desire to become coaches were asked to experience a wellness circle first to ensure their commitment to the program’s ministry and values. When enrollment opened for the next round of wellness circles, there were 30 spaces that filled quickly since there were three trained Christian coaches and each group was capped at ten members. Results and Discussion The positive impact of many of the virtual modifications that were made during the pilot wellness circle was quickly noticed by the KW Chile team as well as by the participants. While changes had been made from necessity and a desire for the program to simply survive the COVID-19 climate, they fostered greater interest in the program and opportunities for expansion. By July, the team had completely restructured the original model of the wellness circle to permanently include many virtual features recently adapted. KW Chile is a new and small non-profit program that mobilizes believers to serve their neighbors in their own communities. While the pilot wellness circle was small, it is of value not only to Kingdom Workers but to other small-to-medium Christian non-profit organizations that operate under similar circumstances of limited staffing, technology, and budgets. While the information from the pilot group is tentative and in need of confirmation over extended time, it is still beneficial in that it provides directional insights that allow for improvement in future programming. In addition, sharing the experiences of KW Chile could potentially foster discussions on best practices and adaptations during COVID-19 amongst smaller Christian non-profit ministries. An initial look at the impact of the first wellness circle showed overall positive movement and growth. KW Chile observed positive movement on the following key outcomes: 1. Participants became more comfortable sharing their faith with others. 2. Participants reported eating more fruits and vegetables, especially those who previously ate 0-1 servings a day. 3. Participants reported an increase in exercise, especially among those who previously exercised 0- 20 minutes per week. 4. Participants were more likely to believe that they have control over the health of their bodies after the support group than before it. Throughout the program, and during the final celebratory gathering, participants were encouraged to share their opinions on the experience. One participant shared his joy in gathering with others regularly and his love of being encouraged by a Christian community, “The more I am in the Word, the more I want to live it and to share it.” Another commented on her realization Christian Relief, Development, and Advocacy 2(2), Winter 2021 Gross and Paltzer, Effects of a Virtual … 89 that her personal health often took the backburner in her life, “I have made improvements! I still have more to improve, but I know that I have grown and will continue to grow.” “There is no doubt that being a part of this initiative has helped me improve my wellness both physically and spiritually. I am thankful for each reflection in the word of God. I felt accompanied in the process, strengthened by God.” Even those unable to complete the circle due to other obligations and meeting changes were supportive of the program, “Thank you so much for allowing me to get to know you. The program seemed excellent to me even though I was not able to fully participate. I began positive changes in my eating habits, and I have continued them.” Of the six participants who completed the pilot wellness circle, two officially trained with KW Chile to become coaches and are now continuing their own wellness growth while encouraging others. The KW Chile team saw drastic changes to their operations once moving online. Growth in online activities encouraged growth in community engagement and knowledge of the program as seen through interactions on the program’s Facebook page. Whereas previously the team had to recruit volunteers and participants, now more people were seeking information about Kingdom Workers themselves. Upon posting a volunteer job application online for a nutritionist, the program received twelve applications from all over Chile. A psychologist contacted the program, desiring to know how she could be a part of it. By far, the greatest impact of moving online has been the accessibility to the program. People tuned into the community healthcare workshops from all over Chile. As of December 2020, one online workshop has 8,100 partial or complete views and approximately twenty-five individuals actively participated in each of the four online workshops. Upon opening the registration for the next round of wellness circles, the program received applicants from cities throughout Chile as well as applicants from countries where the program has sister churches in Colombia and the Dominican Republic. By simply moving the program online, interest grew, volunteer and participant interest grew, and the potential scope of the program grew as well. Limitations The online adaption has several limitations. First, some elderly community members have expressed interest in participating in wellness circles, but they would prefer to do it in-person to feel more comfortable. Second, internet complications cause some participants to drop out of wellness circles especially during periods of quarantine when more people are at home and online causing the internet to be slow or to fail regularly. Third, coaches must be able easily to navigate technology and learn how to facilitate sessions and build relationships virtually. Conclusion Experiencing the pilot wellness circle during a global pandemic forced KW Chile to make immediate changes to the program. While the intent of the program did not change, the implementation and some of the supporting activities and content did. The following are the key takeaways and subsequent next steps: 1. Small wellness circles led by Christian coaches allow for the gospel to be proclaimed not only by coaches, but also by participants, some of whom go on to serve as coaches themselves. Circles will continue to be small and led by volunteers who are passionate about the KW Chile ministry of gospel proclamation and loving one’s neighbors. 2. Certain online elements will remain a permanent part of the program. a. Supplementary activities like fitness accountability groups. b. Facebook Live sound bites featuring wellness habits with community healthcare experts. 3. Wellness Circles will now meet weekly to encourage more accountability and subsequent habit growth. KW Chile program staff will facilitate bi-weekly Zoom theory sessions where numerous wellness circle groups will gather to learn together. In the weeks in between, KW volunteer coaches will meet with their individual wellness circles either virtually or in-person for practice sessions focused on building community and accountability. 4. A completely virtual option for distant participants with the hopes of developing coaches and circles in other areas and countries will be implemented. Coaches can continue to be trained and supported by KW Chile through Zoom. The impact of forced changes to the wellness circle program brought on by COVID-19 introduced many new opportunities that improved the program’s effectiveness and taught the KW Chile team some valuable lessons. Regardless of the continued instability of COVID-19, the program has continued and now provides more benefits to participants and volunteers than was originally hoped. Christian Relief, Development, and Advocacy 2(2), Winter 2021 Gross and Paltzer, Effects of a Virtual … 90 References Bronfenbrenner, U. 1994. “Ecological Models of Human Development.” International Encyclopedia of Education, Vol. 3, 2 nd Ed. Oxford: Elsevier. Reprinted in: Gauvain, M. & Cole, M. (Eds.), Reading on the development of children, 2 nd Ed. (1993, pp. 37-43). NY: Freeman. 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Elise Gross Author email: egross@kingdomworkers.com Jason Paltzer Author email: Jason_Paltzer@baylor.edu http://www.ipsuss.cl/ipsuss/analisis-y-estudios/financiamiento/chile-el-6-pais-con-mayor-prevalencia-de-diabetes-de-la-ocde/2017-12-01/153048.html http://www.ipsuss.cl/ipsuss/analisis-y-estudios/financiamiento/chile-el-6-pais-con-mayor-prevalencia-de-diabetes-de-la-ocde/2017-12-01/153048.html http://www.ipsuss.cl/ipsuss/analisis-y-estudios/financiamiento/chile-el-6-pais-con-mayor-prevalencia-de-diabetes-de-la-ocde/2017-12-01/153048.html http://www.ipsuss.cl/ipsuss/analisis-y-estudios/financiamiento/chile-el-6-pais-con-mayor-prevalencia-de-diabetes-de-la-ocde/2017-12-01/153048.html https://doi.org/10.1007/s10943-019-00876-w https://www.diabetesatlas.org/upload/resources/2019/IDF_Atlas_9th_Edition_2019.pdf https://www.diabetesatlas.org/upload/resources/2019/IDF_Atlas_9th_Edition_2019.pdf https://www.minsal.cl/dia-mundial-de-la-diabetes/ https://www.minsal.cl/wp-content/uploads/2017/11/ENS-2016-17_PRIMEROS-RESULTADOS.pdf https://www.minsal.cl/wp-content/uploads/2017/11/ENS-2016-17_PRIMEROS-RESULTADOS.pdf https://www.minsal.cl/wp-content/uploads/2017/11/ENS-2016-17_PRIMEROS-RESULTADOS.pdf https://doi.org/10.1177/0963721417721526 mailto:egross@kingdomworkers.com mailto:Jason_Paltzer@baylor.edu