WISEWOMAN Consultant Group

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I
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Searching for WISDOM Lessons from the WISEWOMAN
Projects

• Julie C. Will
• Patricia Poindexter
• Centers for Disease Control and Prevention
• Atlanta, Georgia

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General Themes

• Focus on Searching
• Share lessons learned along the way

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Topics

• Overview of WISEWOMAN
• Capturing Grassroots Success
• Sharing Early Lessons Learned
• Describing Best Practices
• Conclusions

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Topics

• Overview of WISEWOMAN
• Capturing Grassroots Success
• Sharing Early Lessons Learned
• Describing Best Practices
• Conclusions

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Vision

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

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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.

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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

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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
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WISEWOMAN 2005
1 of each
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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

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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

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Traditions of the HeartCulturally 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

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RE-AIM Model
From www.re-aim.org
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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
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WISEWOMAN projects have provided more than 60,000
lifestyle intervention sessions
22,973
Intervention Sessions
30,283
8,750
4,122

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Reductions in Systolic Blood Pressure Among
Women with Abnormal Values at Baseline





Reduction in SBP, mmHg
indicates statistical significance at the 5
level
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Reductions in Total Cholesterol Among Women with
Abnormal Values at Baseline



Reduction in TC, mg/dl


indicates statistical significance at the 5
level
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Reductions in Smoking Rate (Percent Change)
Percent Reduction in Smoking Rate
indicates statistical significance at the 5
level
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Reductions in 10-yr CHD Risk (Percent Change)
Percent Reduction in 10-year CHD risk


indicates statistical significance at the 5
level
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WISEWOMAN Projects

• 1995 Massachusetts, North Carolina, Arizona
• 1999 Alaska (Southcentral Foundation)
• Arizona doesnt reapply
• 2000 Iowa, Alaska (SEARHC), Connecticut,
  Michigan, Nebraska, South Dakota, Vermont
• 2001 California and Illinois
• 2003 Missouri and West Virginia
• 2004 Minnesota

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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.
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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.
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Percent of Participants Who Completed At Least
One Intervention Session
Percent
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WISEWOMAN projects have maintained their
screening effort each year
6,800
New Women Screened
12,803
6,371
3,133

1,471
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Topics

• Overview of WISEWOMAN
• Capturing Grassroots Success
• Sharing Early Lessons Learned
• Describing Best Practices
• Conclusions

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WISEWOMAN WORKS A Collection of Success Stories
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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!

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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

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Mary Ellens 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

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Two Sides to Every Story

• TA health professionals

• TA participants

• 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

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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
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Success Stories Categories

• Empowering and Motivating Women
• Expanding Staff Capacity
• Giving Access to Counseling and Medication
• Responding to Womens Needs
• Building Partnerships

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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 theyre
struggling with.Carolyn Townsend,North
Carolina WISEWOMAN Director
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New Leaf is a great tool. It helps us find out
if there are things going on in a womans life
that influence her smoking. Maybe shes worried
shell gain weight if she quits, or maybe shes
depressed, like Sally, and smoking helps her
forget about her problems for a few minutes.
Lori Green,Local WISEWOMAN Coordinator
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WISEWOMAN Works has been used to promote womens
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

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Topics

• Overview of WISEWOMAN
• Capturing Grassroots Success
• Sharing Early Lessons Learned
• Describing Best Practices
• Conclusions

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Lessons Learned From Phase 11995-1998
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Three Original Projects

• Arizona (AZ)
• Massachusetts (MA)
• North Carolina (NC)

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Methods

• Case study design
• Document Reviews
• Telephone Interviews
• Identified cross-case lessons and themes
• Summarized results

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Key Features
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Key Features (contd)
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Key Features (contd)
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RESULTS - REACH

• NBCCEDP implementation stage affects WISEWOMAN
  recruitment
• Multiple channels and personal contact are
  effective
• Outreach into the community is important

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RESULTS- REACH (contd)

• 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

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RESULTS- Effectiveness

• Participant commitment is required
• Agencies and professionals need individualized
  support

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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

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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

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RESULTS- Implementation (Contd)

• 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

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RESULTS- Maintenance

• WISEWOMAN focus on screening and intervention is
  labor intensive

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Topics

• Overview of WISEWOMAN
• Capturing Grassroots Success
• Sharing Early Lessons Learned
• Describing Best Practices
• Conclusions

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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?

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Reach

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

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Effectiveness

• Refers to positive program outcomes minus
  negative program outcomes

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Adoption

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

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Implementation

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

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Maintenance

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

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Combining The Components
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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 gt100
  screenings

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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

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Sites Vary on Measures
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REACH
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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

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ADOPTION

• Calculate minority in each BCCEDP county
• Rank counties highest to lowest
• Scale 0-100
• Assign each WW site that score

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IMPLEMENTATION

• Average number intervention sessions
• Re-screening rates
• Rank highest to lowest
• Calculate average ranking
• Scale 0-100

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MAINTENANCE

• Calculate number of screenings for each 6 month
  period
• Assess if screenings did not decrease by 5
  between periods, decreased by gt 5 over 2
  periods,gt 5 over 3 or more periods
• Calculate change first to last period
• Rank based on highest increase
• Scale 0-100

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2 High and 2 Low Performers
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Best Practices
Best 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
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• 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
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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

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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

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Presentation of Findings

• Monograph
• Manuscript
• Toolkit

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Topics

• Overview of WISEWOMAN
• Capturing Grassroots Success
• Sharing Early Lessons Learned
• Describing Best Practices
• Conclusions

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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