Healthy Weight in Women of Reproductive Age Action Learning Collaborative

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Healthy Weight in Women of Reproductive Age
Action Learning Collaborative

• Salt Lake Valley/Utah Department of Health Team
• Audrey Stevenson, Iliana MacDonald

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The Healthy Weight ActionLearning Collaborative

• Aim to build state and local capacity to help
  women of reproductive age achieve healthy weight
  before, during, and after pregnancy
• Utah, one of eight states who applied for and was
  awarded the opportunity to participate in the ALC

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Utahs Team

• Comprised of partners from
• Utah Department of Health,
• University of Utah Center Of Excellence in
  Womens Health
• Salt Lake Valley Health Department
• WIC Program staff both state and local offices

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Healthy Weight in Women of Reproductive Age in
Utah

• According to 2005 Utah BRFSS Data
• 42.3 of reproductive aged women reported their
  BMI as overweight or obese
• 26.4 of reproductive aged women report eating 5
  or more servings of fruits/vegetables per day
• 59.8 report meeting recommendations for moderate
  or vigorous physical activity
• 83.5 report having no leisure time activities in
  the past month

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Healthy Weight in Women of Reproductive Age in
Utah

• According to WIC PNSS, 2004
• 39.5 of women enrolled in WIC had an
  overweight/obese prepregnancy BMI an increase of
  30 since 1994
• Less than half of WIC enrollees are at a normal
  BMI prior to conception.

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Healthy Weight in Women of Reproductive Age in
Utah

• According to 2004 Utah Vital Records data
• 34.7 of women with a live birth were overweight
  or obese before pregnancy
• An increase of 30 since 1994
• 67.5 of overweight/obese women exceeded the
  Institute of Medicines recommendations for
  weight gain during pregnancy

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Healthy Weight in Women of Reproductive Age in
Utah

• According to a recently published analysis by
  LaCoursierre et al
• Among women who delivered via cesarean section, 1
  in 7 is attributable to being overweight or obese
  prior to pregnancy
• Data also showed an increase in preeclampsia
  rates over the same interval

Am J Obstet Gynecol. 2005 Mar192(3)832-9.
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Healthy Weight in Women of Reproductive Age in
Utah

• Recent Utah PRAMS data found that women who were
  obese prior to pregnancy were at increased risk
  of developing
• diabetes or hypertension,
• delivering a macrosomic infant,
• having labor induced,
• having their infant admitted to the newborn
  intensive care unit,
• reporting postpartum depression

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Healthy Weight in Women of Reproductive Age in
Utah

• Utah PRAMS data also shows that overweight and
  obese women were more likely to have
• lower education levels,
• to be multiparous,
• to be below 200 of the federal poverty level,
  and
• to be enrolled in WIC during pregnancy.

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Healthy Weight in Women of Reproductive Age in
Utah

• An analysis of infant deaths in Utah from 1995 to
  1998 due to perinatal conditions found that obese
  women had significantly higher rates of infant
  death when compared to normal weight women.

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Utahs Short-term goals

• Establishment of strong collaborative
  relationships among appropriate public health
  organizations and agencies to increase Utahs
  capacity to help women of reproductive age
  achieve healthy weight before, during, and after
  pregnancy

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Utahs Short-term goals

• Development of a strategic plan which
  incorporates evidenced based and/or promising
  interventions to address the increasing
  prevalence of overweight/obesity among women of
  reproductive age in Utah

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Utahs Long-term (5-yrs plus) Vision

• Reversal of the increasing percentages of women
  with unhealthy pre-pregnancy weight and
  inappropriate weight gain during pregnancy by
  implementing system and program changes that
  impact weight status and weight retention among
  pregnant and lactating Utah women.

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Utahs Long term goals

• Establishment of ongoing, sustainable
  collaboration between key partners
• Implementation and evaluation of promising
  interventions in Salt Lake County WIC clinics to
  help women of reproductive age achieve healthy
  weight before, during, and after pregnancy
• Expansion of successful interventions to WIC
  clinics and other appropriate populations
  throughout Utah to help women of reproductive age
  achieve healthy weight before, during, and after
  pregnancy
• Implementation and evaluation of reproductive
  health care provider system changes e.g.,
  provider education and tools to assist them in
  identifying high risk women and delivering a
  healthy weight message during provider visits
• Reversal of the trend of increasing rates of
  overweight/obesity among women of reproductive
  age in Utah

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Next Steps

• Key informant surveys of WIC staff to ID barriers
  to counseling
• Focus groups (3-5) with pregnant, postpartum,
  interconceptional overweight and obese women to
  ID assets/barriers to healthy weight
• Chart reviews to ascertain provider practices r/t
  ID and addressing overweight/obesity during
  prenatal
• Bright Futures for Womens Health and Wellness
  Program Implementation

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Next Steps Key Informant survey

• 25 surveys distributed, 23/25 92 return rate
• Dietitian/Nutrition Assistants Salt Lake County
  WIC clinics

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Key Informant Results

• Question 1 What challenges do you face, if any,
  in addressing healthy weight among the WIC
  clients you counsel?

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Key Informant Results

• Question 2 What training/education does WIC
  need to provide to staff in order for you to
  adequately address healthy weight with WIC
  clients?

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Key Informant Results

• Question 3 Is the WIC program doing enough to
  address healthy weight among clients? If not,
  what recommendations can you make that will help
  WIC improve in this area?
• Yes (10) 43
• No (12) 52

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Key Informant Results

• Question 4 What barriers prevent you from
  discussing overweight/obesity issues with
  clients?

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Key Informant Results

• Question 5 In your opinion, do you feel
  supported by community health care providers in
  addressing overweight/obesity issues?

Some respondents checked both yes and no on this
item.
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Key Informant Results

• Question 6 How receptive are clients about
  receiving healthy weight information?

Some respondents answered both positively and
negatively for this question.
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Key Informant Results

• Question 7 How comfortable are you in
  discussing healthy weight issues? Please
  elaborate further on your answer.

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Key Informant Results

• Question 8 What resources is WIC providing for
  clients that you use during counseling of healthy
  weight?

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Key Informant Results

• Question 9 What additional resources would be
  helpful to you during counseling?

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Key Informant Results

• Question 10 What types of counseling strategies
  or information do you usually discuss with
  clients when addressing the issue of healthy
  weight?

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Key Informant Results

• Question 11 What types of counseling techniques
  do you find to be most effective?

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Focus Groups

• Focus groups (3-5) with pregnant, postpartum,
  interconceptional overweight and obese women to
  ID assets/barriers to healthy weight
• Funding secured from Region VIII OWH to provide
  incentives, daycare and light healthy
  refreshments
• English and Spanish facilitators

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Focus Groups

• Discussion themes
• Explore knowledge/beliefs around relationship
  between healthy weight and pregnancy outcomes
• Explore knowledge/beliefs around relationship
  between healthy weight and prevention of chronic
  disease
• Explore cultural beliefs/traditions/lifestyle
  issues that contribute to unhealthy weight

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Focus Groups

• Explore knowledge/beliefs around importance of
  5-a-day
• Explore knowledge/beliefs around physical
  activity recommendations (_at_ least 30 min./day
  most days of week)
• Explore knowledge/beliefs about role of
  breastfeeding in maintaining a healthy weight
• Brainstorm interventions that would promote
  healthy weight

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Chart review project

• Prenatal medical record review (University of
  Utah and SLVHD clinics) assessing
• Providers demographic info
• Pre-pregnancy height and weight recorded
• BMI calculated
• If BMI 30, listed on problem list

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Project Implementation

• The Bright Futures program will be implemented at
  two clinics (South Main Public Health Center,
  Ellis Shipp Public Health Center)
• Women who receive MCH services at these two sites
  also participate in WIC
• Project will be evaluated after one year

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Bright Futures

• My Bright Future Physical Activity And Healthy
  Eating Guide for Adult Women
• Getting Started Questions to answer on your own
  and talk about with your health care provider.
• Healthcare Provider Ideas on how to start a
  conversation with your health care provider and
  examples of questions you can ask.
• My Healthcare visit Section for your health care
  provider to fill out during your visit.
• Setting My goals Charts for setting goals with
  your health care provider (or on your own).
• What I Should Know Information and ideas to help
  you reach your goals.
• Hints For Reaching My Goal More ideas to help
  you meet your goals.
• Getting More Information Other resources to help
  you.

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• ABOUT THE BRIGHT FUTURES FOR WOMENS HEALTH AND
  WELLNESS INITIATIVE
• The Bright Futures for Womens Health and
  Wellness (BFWHW) initiative is a project of the
  U.S.
• Department of Health and Human Services Health
  Resources and Services Administration (HRSA),
• Office of Womens Health.
• The mission of BFWHW is to plan, develop,
  implement, and evaluate a variety of culturally
  competent consumer, provider, and community-based
  products for all women across their
  lifespanincluding underserved and minority
  women.
• The Bright Futures materials
• help to promote womens physical, emotional,
  social, and spiritual health and well-being.

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Bright Futures
http//www.hrsa.gov/womenshealth/toolkit/menu.html
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Challenges

• Focus group recruitment
• Keeping partners engaged
• Maintaining flexibility needed to revise
  interventions
• Acquiring incentive monies for focus groups

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Questions?
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Contact information

• astevenson_at_slco.org
• imacdonald_at_slco.org