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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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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
slide9
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 Among 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 Among 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 (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 (Percent Change)

Percent

Reduction

in 10-year

CHD risk

*

*

* indicates statistical significance at the 5% level

wisewoman projects
WISEWOMAN Projects

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

slide23
Adoption: Length of Time from Funding to 1st Screening and

1st to 500th Woman Screened.

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

slide24
Adoption: Length of Time from Funding to 1st Screening and

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
  • Overview of WISEWOMAN
  • Capturing Grassroots “Success”
  • Sharing Early Lessons Learned
  • Describing Best Practices
  • Conclusions
why use success stories
Why Use Success Stories?
  • 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
  • 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
  • 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

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
  • Empowering and Motivating Women
  • Expanding Staff Capacity
  • Giving Access to Counseling and Medication
  • Responding to Women’s Needs
  • Building Partnerships
slide37
“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
slide38
“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 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
  • Overview of WISEWOMAN
  • Capturing Grassroots “Success”
  • Sharing Early Lessons Learned
  • Describing Best Practices
  • Conclusions
three original projects
Three Original Projects

Arizona (AZ)

Massachusetts (MA)

North Carolina (NC)

methods
Methods
  • Case study design
    • Document Reviews
    • Telephone Interviews
  • Identified cross-case lessons and themes
  • Summarized results
results reach
RESULTS - REACH
  • 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)
  • 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
  • Participant commitment is required
  • Agencies and professionals need individualized support
results adoption
RESULTS- Adoption
  • 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
  • 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)
  • 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
  • WISEWOMAN focus on screening and intervention is labor intensive
topics4
Topics
  • Overview of WISEWOMAN
  • Capturing Grassroots “Success”
  • Sharing Early Lessons Learned
  • Describing Best Practices
  • Conclusions
the wisewoman challenge
The WISEWOMAN Challenge
  • 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

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

effectiveness
Effectiveness

Refers to positive program outcomes minus negative program outcomes

adoption
Adoption

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

implementation
Implementation

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

maintenance
Maintenance

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

methods1
Methods
  • 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
  • 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
effectiveness1
EFFECTIVENESS
  • 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
  • Calculate % minority in each BCCEDP county
  • Rank counties highest to lowest
  • Scale 0-100
  • Assign each WW site that score
implementation1
IMPLEMENTATION
  • Average number intervention sessions
  • Re-screening rates
  • Rank highest to lowest
  • Calculate average ranking
  • Scale 0-100
maintenance1
MAINTENANCE
  • 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
slide72
Best Practices

“…[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

slide73
Select projects and sites for case studies
  • Review project-specific documents
  • Telephone interviews, with program staff
  • Qualitative data collection: Site visits, observations, focus groups

Site Visit Case Studies

slide74
Data Collection Tools
  • 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
slide75
Data Analysis Goals
  • 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
slide76
Presentation of Findings
  • Monograph
  • Manuscript
  • Toolkit
topics5
Topics
  • Overview of WISEWOMAN
  • Capturing Grassroots “Success”
  • Sharing Early Lessons Learned
  • Describing Best Practices
  • Conclusions
conclusions
Conclusions
  • 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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