Well-Integrated Screening And Evaluation For Women Across The Nation Research Articles

Implementing the WISEWOMAN Program in Local Health Departments: Staff Attitudes, Beliefs, and Perceived Barriers

Although most health departments recognize the need for programs to reduce the risk of cardiovascular disease (CVD) among older, low-income women, they face numerous barriers to successfully implementing such programs. This paper explores counselors' attitudes and beliefs about patients and perceived barriers to implementing the North Carolina Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program. Health departments were assigned to provide patients with either an enhanced intervention (EI) or a minimum intervention (MI). Cross-sectional baseline and 12-month follow-up surveys were completed by health department counselors designated to deliver the MI or EI. Both surveys addressed counselors' beliefs about patients' motivation and attitudes, their counseling practices, and their personal diet and physical activity behaviors and attitudes. The follow-up survey also addressed opinions about the feasibility of long-term WISEWOMAN implementation. Counselors were skeptical about patients' motivation to improve their lifestyle, citing high perceived cost and burden. At follow-up, EI counselors reported having higher self-efficacy for counseling, incorporating more behavioral change strategies, and spending more time counseling than did counselors at MI sites. They were also more likely to report making healthful personal lifestyle choices. All counselors identified lack of time as a major barrier to counseling, and most cited obtaining low-cost medications for patients, ensuring that patients made follow-up visits, and implementing the program with existing staff as key challenges to the long-term sustainability of WISEWOMAN. Our findings provide insight into the organizational challenges of implementing a CVD risk-reduction program for low-income women. We discuss ways in which intervention and training programs can be improved.

Extending the reach of public health nutrition: training community practitioners in multilevel approaches.

Cardiovascular disease (CVD) is a major public health concern in the United States. We developed an annual training course, Nutrition and Public Health, A Course for Community Practitioners (NPH), to address the identified training needs of state staff responsible for designing and implementing the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program and to support other health professionals working in programs that address chronic disease prevention and management. After conducting a needs assessment with state-level WISEWOMAN staff in 2001 to identify topics of interest, we formed an advisory committee to provide guidance on topics, theoretical frameworks, training concerns, and multilevel intervention approaches. The first week-long training course, which included an intensive field practicum, was implemented in the fall of 2002. Participants rated three fourths of the elements listed in a posttraining evaluation as a course strength, giving particularly high ratings to various indicators of course quality (100%) and networking opportunities (95%). Just over half (55%) rated the field practicum as a course strength. Four fifths (83%) of participants responded to a 6-month follow-up evaluation, and most indicated that the course had increased their knowledge and skills and increased their confidence in planning programs. Unique features of the course include its suitability for public health practitioners not previously trained in nutrition, its promotion of multilevel interventions, and its focus on CVD risk reduction and nutrition interventions for underinsured and uninsured populations.

A replicable process for redesigning ethnically relevant educational materials.

To serve the populations targeted by Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) effectively, healthcare providers need educational materials that are evidence based and ethnically relevant and can be easily incorporated into busy clinic settings. We describe a replicable process used to redesign and tailor physical activity and diet education materials for African American women in the southeastern United States. The process consists of seven phases. Quantitative and qualitative analyses were used on data gathered in 2000 from two expert panels and eight focus groups. Expert panelists preferred materials perceived to be high quality, easy to understand, organized to facilitate use by healthcare providers, and with content relevant to African American women. Focus group participants were mostly concerned with the visual appeal and content of educational materials. They liked high-quality materials that are brief; avoid jargon and use simple language, bright colors, and photographs; and provide useful information that acknowledges the context of their lives, including their family roles. The redesign process can produce ethnically and culturally appropriate educational materials for use by WISEWOMAN providers and other healthcare providers in conjunction with cardiovascular (CVD) risk reduction and behavioral counseling. To be effective, materials must address the needs and concerns of both providers and patients.

Obesity and Associated Coronary Heart Disease Risk Factors in a Population of Low-Income African-American and White Women: The North Carolina WISEWOMAN Project

Background. Obesity has been associated with many co-occurring coronary heart disease (CHD) risk factors as well as CHD mortality. These associations have been shown to vary between African-American and white sample populations.Methods. The authors examined whether obesity co-occurs with several CHD risk factors (diabetes, hypertension, hypercholesterolemia, low high-density lipoprotein cholesterol (HDL-C)), and estimated the 10-year risk for CHD in the North Carolina WISEWOMAN (Well Integrated Screening and Evaluation for Women Across the Nation) study sample. This sample includes low-income African-American and white women (≥50 years of age).Results. Among white women (n = 1,284), 34% were overweight (BMI = 25.0–29.99 kg/m2) and 35% obese (BMI ≥ 30 kg/m2); among African-American women (n = 754), 28% were overweight and 59% obese. Among obese and nonobese African-American women, the prevalence of three or more co-occurring risk factors was similar (obese = 17.7% (95% confidence interval (CI): 13.9, 21.6) and nonobese = 13.3% (95% CI: 8.7, 17.8)). By contrast, the prevalence among white women was greater among the obese (26.9% (95% CI: 22.9, 31.0)) than the nonobese (13.0% (95% CI: 9.7, 16.2)).Conclusions. The differences between and within African-American and white women may be accounted for by the high levels of HDL-C among obese and nonobese African-American women.