The centrality of the church in African American communities makes it a culturally compelling sponsor for health promotion activities targeting health disparities among the medically underserved. Pastoral support is critical in determining whether a church initiates or supports a health promotion agenda, but there is little understanding of the variables that influence this decision. The aim of the qualitative study was to investigate the perceptions of African American pastors regarding the decision to incorporate health promotion programs in their churches. This study was guided by the health belief model using a phenomenological approach. Data were collected using both semi-structured and open-ended interviews. Ten pastors of North Carolina African American churches, with and without health promotion ministries, were recruited for the study. Eight pastors agreed to participate in the study. They were interviewed, and interviews were recorded and transcribed. The data were open coded and analyzed. NVivo 11 was used to manage the data. Five themes emerged from the study: the importance of health promotion, pastor support of a health promotion program, pastor influence on individuals in the congregation, the health status of church members, and barriers and facilitators. Positive social change may be realized by using this information to increase the effectiveness of culturally sensitive health information and developing health education programs that specifically target the African American faith community. Information from this research could help guide public health agencies on how to approach health programming in this specific area and for this population.