Critical Lessons in Tailoring Interventions: Listening to WISEWOMAN Participants.

Abstract

To explore perspectives of participants in the WISEWOMAN program in Pennsylvania (PA-WISE) on challenges and facilitators of reducing cardiovascular disease risk as low-income and un-/under-insured middle-aged women. Researchers conducted this 2year qualitative data collection as one component of a broader, 5year PA-WISE process and outcome evaluation. Women from across Pennsylvania, primarily from rural communities. Interviewees were low-income, un-/under-insured women aged 40-64years who had recently participated in PA-WISE-facilitated health coaching and lifestyle programs (HC/LSPs). Researchers conducted individual telephone interviews with 38 women from four discrete samples of PA-WISE participants at 4time points. Three researchers used grounded theory, and an iterative process of line-by-line coding, data display, and reanalysis to identify emerging themes, sub-themes, and their relationships. Participants shared the important benefits of specific PA-WISE program traits. However, participants described significant financial constraints, difficult schedules, caregiving responsibilities, and insufficient social support as persistent challenges in their lives, making lifestyle changes in general, and program participation specifically, difficult. The challenges that low-income and un-/under-insured women identified amplify the importance of having interventions that offer flexibility, options, and tailoring of supports and resources. The timeless challenges articulated by participants in this study completed just before the COVID-19 pandemic, remain relevant to be addressed through the pandemic and beyond.