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I. Searching for WISDOM: Lessons from the WISEWOMAN Projects. Julie C. Will Patricia Poindexter Centers for Disease Control and Prevention Atlanta, Georgia. General Themes. Focus on “Searching” Share lessons learned along the way. Topics. Overview of WISEWOMAN

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I


Searching for wisdom lessons from the wisewoman projects
Searching for WISDOM: Lessons from the WISEWOMAN Projects

Julie C. Will

Patricia Poindexter

Centers for Disease Control and Prevention

Atlanta, Georgia


General themes
General Themes

  • Focus on “Searching”

  • Share lessons learned along the way


Topics
Topics

  • Overview of WISEWOMAN

  • Capturing Grassroots “Success”

  • Sharing Early Lessons Learned

  • Describing Best Practices

  • Conclusions


Topics1
Topics

  • Overview of WISEWOMAN

  • Capturing Grassroots “Success”

  • Sharing Early Lessons Learned

  • Describing Best Practices

  • Conclusions


Vision
Vision

  • A world where any woman can access preventive health services and gain the wisdom to improve her health.


Mission
Mission

  • To provide low-income, under- or uninsured 40-64 year old women with the knowledge, skills, and opportunity to improve diet, physical activity, and other lifestyle behaviors to prevent, delay and control cardiovascular and other chronic diseases.


Wisewoman components
WISEWOMAN Components

  • Baseline screening for cardiovascular disease risk factors

  • Lifestyle interventions sessions

  • Referral for medical care, if needed

  • Systems for accessing low-cost medications

  • One-year follow-up screening


Abnormal

Medical

referral &

Follow-up

Alert

Immediate

medical referral

Ensure

treatment

Recruited

from

B and C

Program

Cardiovascular

Risk Factor

Screening

Risk Factor

Counseling

Lifestyle

intervention

for diet, physical

activity and/or

tobacco

More active

Better diet

Decreased

smoking

Reduced

CVD

risk factors

Diagnostic

tests.

Enrolled in

intervention

Medical

treatment

if needed


Wisewoman 2005

Standard

Enhanced

WISEWOMAN 2005

1 of each


Interventions vary by project

New Leaf

Patient-centered Assessment and Counseling for Exercise & Nutrition

Project Active

Dietary Approaches to Stop Hypertension (DASH)

Dietary Guidelines for Americans

10,000 Steps

State Quitlines

Smoking Cessation Classes

Interventions Vary By Project


Vida saludable coraz n contento promoting healthy living and a happy heart in latino women
¡Vida Saludable, Corazón Contento!: Promoting Healthy Living and a Happy Heart in Latino Women

  • Needed intervention materials for Spanish-speaking women

  • Culturally appropriate adaptation process of A New Leaf

  • Multiple-level material design, evaluation and revision


Traditions of the heart culturally sensitive program promotes health for alaska native women
Traditions of the Heart:Culturally Sensitive Program Promotes Health For Alaska Native Women

  • Needed easily understood intervention for lay and professional use

  • Tailored A New Leaf for Alaska Native women

  • Formative research essential for culturally appropriate materials


Re aim model
RE-AIM Model

From www.re-aim.org


Wisewoman projects have reached more than 30 000 low income women across america
WISEWOMAN projects have reached more than 30,000 low-income women across America

6,800

New

Women

Screened

12,803

6,371

3,133

1,471


Wisewoman projects have provided more than 60 000 lifestyle intervention sessions
WISEWOMAN projects have provided more than 60,000 lifestyle intervention sessions

22,973

Intervention

Sessions

30,283

8,750

4,122


Reductions in systolic blood pressure among women with abnormal values at baseline
Reductions in Systolic Blood Pressure intervention sessionsAmong Women with Abnormal Values at Baseline

*

*

*

*

*

Reduction

in SBP,

mmHg

* indicates statistical significance at the 5% level


Reductions in total cholesterol among women with abnormal values at baseline
Reductions in Total Cholesterol intervention sessionsAmong Women with Abnormal Values at Baseline

*

*

*

Reduction

in TC,

mg/dl

*

*

* indicates statistical significance at the 5% level


Reductions in smoking rate percent change
Reductions in Smoking Rate intervention sessions(Percent Change)

Percent

Reduction

in Smoking

Rate

* indicates statistical significance at the 5% level


Reductions in 10 yr chd risk percent change
Reductions in 10-yr CHD Risk intervention sessions(Percent Change)

Percent

Reduction

in 10-year

CHD risk

*

*

* indicates statistical significance at the 5% level


Wisewoman projects
WISEWOMAN Projects intervention sessions

1995: Massachusetts, North Carolina, Arizona

1999: Alaska (Southcentral Foundation)

Arizona doesn’t reapply

2000: Iowa, Alaska (SEARHC), Connecticut, Michigan, Nebraska, South Dakota, Vermont

2001: California and Illinois

2003: Missouri and West Virginia

2004: Minnesota


Adoption: Length of Time from Funding to 1st Screening and intervention sessions

1st to 500th Woman Screened.

Projects designated as NON-RESEARCH at the time of funding award.


Adoption: Length of Time from Funding to 1st Screening and intervention sessions

1st to 500th Woman Screened.

Projects designated as RESEARCH at the time of funding award.

*Project J has not started screening women yet; the number of days is from the date of funding to 4/15/05.



Wisewoman projects have maintained their screening effort each year
WISEWOMAN projects have maintained their screening effort each year

6,800

New

Women

Screened

12,803

6,371

3,133

1,471


Topics2
Topics each year

  • Overview of WISEWOMAN

  • Capturing Grassroots “Success”

  • Sharing Early Lessons Learned

  • Describing Best Practices

  • Conclusions


Wisewoman works a collection of success stories
WISEWOMAN WORKS: each year A Collection of Success Stories


Why use success stories
Why Use Success Stories? each year

  • Qualitative complements quantitative research

  • Simple, one-page format more likely to be read than other formats

  • Pictures and quotes personalize program results

  • Supports WISEWOMAN funding

  • Everyone likes stories!


Reaching multiple audiences through success stories
Reaching Multiple Audiences Through Success Stories each year

  • Congress/Decision makers

    • Engage or gain support

    • Facilitate decision making

  • Health care providers

    • Generate new ideas

    • Adapt and adopt “successful” ideas

    • Share information - nontraditional publications

  • Women

    • Expand reach through program promotion

    • Foster social support

    • Incentive


Mary ellen s story right on time for her health
Mary Ellen’s Story: Right on Time for Her Health each year

  • WISEWOMAN helped Mary Ellen approach health holistically

  • Positive and encouraging staff set health goals together

  • She is now a WISEWOMAN “champion”


Two sides to every story

TA: health professionals each year

TA: participants

Version 1

Version 2

Two Sides to Every Story

  • Quote from Mary Ellen

  • Picture of Mary Ellen

  • Program background/wordy

  • Less text/more benefits

  • Lessons learned focuses on key elements of a successful program

  • Lessons learned focuses on why women like Mary Ellen should attend the program

  • Uses: New programs, training staff, shared lessons

  • Uses: Recruitment and outreach; Incentive


Healthwise partnership promotes physical activity for wisewoman participants in winston salem
Healthwise Partnership Promotes Physical Activity for WISEWOMAN Participants in Winston-Salem

WISEWOMAN

YWCA

Diabetes Control

United Way

YWCA Scholarships Reduce Cost and Access Barriers for Women


Success stories categories
Success Stories Categories WISEWOMAN Participants in Winston-Salem

  • Empowering and Motivating Women

  • Expanding Staff Capacity

  • Giving Access to Counseling and Medication

  • Responding to Women’s Needs

  • Building Partnerships


“These women are dealing with a number of issues: poverty, health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”Carolyn Townsend,North Carolina WISEWOMAN Director


health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”New Leaf is a great tool. It helps us find out if there are things going on in a woman’s life that influence her smoking. Maybe she’s worried she’ll gain weight if she quits, or maybe she’s depressed, like Sally, and smoking helps her forget about her problems for a few minutes.” Lori Green,Local WISEWOMAN Coordinator


Wisewoman works has been used to promote women s heart health in a number of ways
WISEWOMAN Works health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.” has been used to promote women’s heart health in a number of ways.

Success stories can:

  • Offer a low-cost way to document program success

  • Help programs gain support for successful activities

  • Inform others about successful program interventions

  • Acknowledge the innovative strategies used by program staff and partners


Topics3
Topics health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

  • Overview of WISEWOMAN

  • Capturing Grassroots “Success”

  • Sharing Early Lessons Learned

  • Describing Best Practices

  • Conclusions


Lessons learned from phase 1 1995 1998
Lessons Learned From Phase 1: health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”1995-1998


Three original projects
Three Original Projects health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

Arizona (AZ)

Massachusetts (MA)

North Carolina (NC)


Methods
Methods health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

  • Case study design

    • Document Reviews

    • Telephone Interviews

  • Identified cross-case lessons and themes

  • Summarized results


Key features
Key Features: health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”


Key features cont d
Key Features (cont’d): health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”


Key features cont d1
Key Features (cont’d): health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”


Results reach
RESULTS - REACH health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

  • NBCCEDP implementation stage affects WISEWOMAN recruitment

  • Multiple channels and personal contact are effective

  • Outreach into the community is important


Results reach cont d
RESULTS- REACH (cont’d) health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

  • Recruitment is enhanced when funds are designated for outreach

  • Program participation may be influenced by the types of no-cost services offered

  • Participation may be affected by general barriers and lifestyle behavior specific barriers


Results effectiveness
RESULTS- Effectiveness health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

  • Participant commitment is required

  • Agencies and professionals need individualized support


Results adoption
RESULTS- Adoption health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

  • WISEWOMAN focus on screening and intervention is labor intensive

  • Blending programs with different emphases and aims can be difficult - streamline WISEWOMAN to fit the NBCCEDP approach

  • Intervention should have a flexible design to accommodate individual, group or phone sessions


Results implementation
RESULTS- Implementation health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

  • Research:

    - can be overwhelming to service providers and agencies

  • is poorly understood by service providers

  • Limits program flexibility and imposes extra requirements

  • Requires commitment and adequate resources


Results implementation cont d
RESULTS- Implementation (Cont’d) health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

  • Projects need a planning phase

  • Projects benefit from buy-in at all levels

  • Providers need appropriate onsite training

  • WISEWOMAN calls for changes in provider attitudes and behaviors


Results maintenance
RESULTS- Maintenance health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

  • WISEWOMAN focus on screening and intervention is labor intensive


Topics4
Topics health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

  • Overview of WISEWOMAN

  • Capturing Grassroots “Success”

  • Sharing Early Lessons Learned

  • Describing Best Practices

  • Conclusions


The wisewoman challenge
The WISEWOMAN Challenge health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

  • We model our WISEWOMAN interventions on clinical trials that demonstrate an intervention is efficacious

  • However, these interventions are studied in a rarified environment

  • What will it take to make these interventions work in busy, understaffed public health clinics, large health systems, or community settings?


Reach
Reach health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

Refers to the proportion and representativeness of the target population that participates in the program


Effectiveness
Effectiveness health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

Refers to positive program outcomes minus negative program outcomes


Adoption
Adoption health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

The Proportion and Representativeness of Settings That Adopt Given Policy or Program


Implementation
Implementation health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

Refers to The Extent to Which a Program Is Delivered As Designed


Maintenance
Maintenance health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

Refers to The Extent to Which a Program Is Sustained Over Time


Combining the components
Combining The Components health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”


Methods1
Methods health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

  • Used RE-AIM framework to rank sites within one project

  • Developed a list of RE-AIM measures based on currently available data:

    • WISEWOMAN MDEs (July 2001- June 2003)

    • BCCEDP MDEs (July 1999 – June 2003)

  • Present results for 14 sites with >=100 screenings


Reach1
REACH health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

  • Number of screenings7/2001-6/2003

  • Number of first time screenings

  • % BCCEDP screened

  • % minority screened

  • % attending one intervention

  • Rank each site highest to lowest

  • Calculate average ranking for each site and scale from 0-100


Sites vary on measures
Sites Vary on Measures health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”


Reach2
REACH health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”


Effectiveness1
EFFECTIVENESS health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

  • Average change in systolic BP

  • Average change in cholesterol

  • Average change in body weight

  • Average change in smoking rate

  • Rank each component highest to lowest

  • Calculate average ranking for each site

  • Scale rankings o-100


Adoption1
ADOPTION health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

  • Calculate % minority in each BCCEDP county

  • Rank counties highest to lowest

  • Scale 0-100

  • Assign each WW site that score


Implementation1
IMPLEMENTATION health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

  • Average number intervention sessions

  • Re-screening rates

  • Rank highest to lowest

  • Calculate average ranking

  • Scale 0-100


Maintenance1
MAINTENANCE health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

  • Calculate number of screenings for each 6 month period

  • Assess if screenings did not decrease by 5% between periods, decreased by > 5% over 2 periods,> 5% over 3 or more periods

  • Calculate % change first to last period

  • Rank based on highest % increase

  • Scale 0-100


2 high and 2 low performers
2 High and 2 Low Performers health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”


Best Practices health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

“…[B]est practices [are] activities that reliable evidence shows to be effective and efficient for delivering WISEWOMAN services to the target population of underserved women and that support and follow from an articulated model or theory.”

(Mays, Hesketh, Briefel, 2003).

From August 2002 meeting of WISEWOMAN Consultant Group


  • Select projects and sites for case studies health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

  • Review project-specific documents

  • Telephone interviews, with program staff

  • Qualitative data collection: Site visits, observations, focus groups

Site Visit Case Studies


Data Collection Tools health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

  • Semi-structured interview protocols for each type of respondent

  • Focus group protocols (+ tape and transcribe)

  • Observation checklists

  • Templates for collecting and organizing project background information, interview results, observation notes


Data Analysis Goals health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

  • Describe projects at each stage of development

  • Categorize projects by service delivery type

  • Identify effective program practices for each RE-AIM component

  • Disseminate findings in accessible products


Presentation of Findings health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

  • Monograph

  • Manuscript

  • Toolkit


Topics5
Topics health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

  • Overview of WISEWOMAN

  • Capturing Grassroots “Success”

  • Sharing Early Lessons Learned

  • Describing Best Practices

  • Conclusions


Conclusions
Conclusions health problems, and addiction. We try to be someone they can talk to about what they’re struggling with.”

  • Broad evaluation framework needed

  • Look at success from a variety of perspectives

  • Full intervention attendance is a challenge

  • Adoption of WISEWOMAN is not easy in every setting

  • Comprehensive approach is a new way of thinking for many providers

  • Free services, flexible delivery of services, and incentives are important

  • Research is rarely appreciated in busy clinics

  • Learn from high performing sites


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