Theory-based assessment of congregant expectations and needs should be cond
ucted prior to beginning a parish nurse program. However, no such assessmen
ts are found in the literature. Using Andersen's Health Access Model as a f
ramework, investigators conducted interviews with 117 randomly selected con
gregants in five urban African American churches to describe their perceive
d needs and expectations. Causing most concern were the following: (a) symp
toms of illness-high blood pressure (50.4%), dental problems (43.6%), and b
ack pain (41%); and (b) health habits/risks-weight (75%), exercise (63%), a
nd diet (63%). Younger adults were significantly more concerned about all a
spects of their health than their older counterparts. Women were significan
tly more likely to express concern about health habits and health risks tha
n males. No significant relationship was found between perceived need and a
ccess to care. Although terming health care services "adequate", congregant
s expressed many unmet health needs. This seemingly contradictory finding m
ay illuminate a concrete role for the parish nurse, i.e., addressing person
al health care concerns not alleviated by the current "adequate" health car
e delivery system. This study's significance lies not only in providing pro
gramming guidance, but also in theoretical insights into the role of the pa
rish nurse.