intervention planning, program development, and implementation health works for women/health works...

Intervention Planning, Program Intervention Planning, Program Development, and ImplementationDevelopment, and Implementation

Health Works for Women/Health Health Works for Women/Health Works in the Community and Works in the Community and

HOPE WorksHOPE Works

Nutrition and Public Health Nutrition and Public Health

Salli Benedict, MPHSalli Benedict, MPH

August 23, 2006August 23, 2006

Health Works for Women/Health Health Works for Women/Health Works in the Community and Works in the Community and

HOPE WorksHOPE WorksUNC Center for Health Promotion UNC Center for Health Promotion

and Disease Preventionand Disease Prevention

Centers for Disease Control and Prevention Funded Centers for Disease Control and Prevention Funded Marci K. Campbell, PhD, RD, MPHMarci K. Campbell, PhD, RD, MPH

Salli Benedict, MPHSalli Benedict, MPHLeigh Belton, MA Leigh Belton, MA

Margaret Bentley, PhDMargaret Bentley, PhDRonni Bowen, PhDRonni Bowen, PhD

Brenda DeVellis, PhDBrenda DeVellis, PhDChantelle Fisher-Borne, MPHChantelle Fisher-Borne, MPH

Elizabeth Hooten, PhDElizabeth Hooten, PhDKristine Kelsey, PhDKristine Kelsey, PhD

Promoting the Health of Promoting the Health of Rural Blue Collar Women in the Rural Blue Collar Women in the

WorkplaceWorkplace

Health Works for Women-1 Health Works for Women-1

(1993-1998)(1993-1998)

9 manufacturing plants; healthy 9 manufacturing plants; healthy eating, physical activity, cancer eating, physical activity, cancer screening, and smoking; 2 levels of screening, and smoking; 2 levels of socio-ecologic modelsocio-ecologic model

Promoting the Health of Promoting the Health of Rural Blue Collar Women in the Rural Blue Collar Women in the Workplace and the CommunityWorkplace and the Community

Health Works for Women Health Works for Women 2/Health Works in the 2/Health Works in the Community Community (1998-2003)(1998-2003)Builds on HWW-1; 12 manufacturing Builds on HWW-1; 12 manufacturing plants; stress, healthy eating, plants; stress, healthy eating, physical activity and smoking; new physical activity and smoking; new populations and worksites; 4 levels of populations and worksites; 4 levels of socio-ecologic modelsocio-ecologic model

Overall Goal: to reduce morbidity and Overall Goal: to reduce morbidity and mortality among low income working women mortality among low income working women

in Eastern N.C.in Eastern N.C.

Heart diseaseHeart disease Obesity Obesity CancerCancer HypertensionHypertension DiabetesDiabetes

Improve health behaviors that contribute to Improve health behaviors that contribute to leading causes of morbidity leading causes of morbidity

and mortalityand mortality

Decrease smokingDecrease smoking Increase fruit and vegetable intakeIncrease fruit and vegetable intake Decrease dietary fatDecrease dietary fat Reduce stress levelsReduce stress levels Increase physical activityIncrease physical activity

Participant Characteristics Participant Characteristics (1166 women)(1166 women)

68% overweight or obese68% overweight or obese 6% eat 5 a day; 33% eat low fat6% eat 5 a day; 33% eat low fat 25% exercise 3x week (with ADL & 25% exercise 3x week (with ADL &

work)work) 26% currently smoke; 38% live with 26% currently smoke; 38% live with

smokersmoker 78% felt nervous/stressed most or 78% felt nervous/stressed most or

some of the time in last monthsome of the time in last month

MATCHMATCH

Phase I: Goal SelectionPhase I: Goal Selection Phase II:Phase II: Intervention Intervention

PlanningPlanning Phase III: Program DevelopmentPhase III: Program Development Phase IV: Implementation Phase IV: Implementation Phase V: EvaluationPhase V: Evaluation

Intervention Planning: select theory-Intervention Planning: select theory-based approachesbased approaches

Individual Individual ~ tailored health ~ tailored health messagesmessages

Interpersonal Interpersonal ~ lay health advisor ~ lay health advisor programsprograms

OrganizationalOrganizational ~ employee wellness ~ employee wellness committee projectscommittee projects

Community-societalCommunity-societal ~ Community ~ Community Advisory Committee projectsAdvisory Committee projects

Intervention Planning: Choose Objectives Intervention Planning: Choose Objectives and Targetand Target

1. Provide health information and 1. Provide health information and practical strategies to helppractical strategies to help individual individual female employees change unhealthy female employees change unhealthy behaviors (nutrition, smoking, behaviors (nutrition, smoking, physical activity, weight physical activity, weight management, and stress).management, and stress).

Intervention Planning: Choose Objectives Intervention Planning: Choose Objectives and Targetand Target

2. Provide information and practical 2. Provide information and practical strategies to strategies to groupsgroups of female of female employees for supporting co-workers employees for supporting co-workers in efforts to improve health in efforts to improve health behaviors.behaviors.

Intervention Planning: Choose Objectives Intervention Planning: Choose Objectives and Targetand Target

3. Provide consulting and practical 3. Provide consulting and practical assistance to employee wellness assistance to employee wellness committees to increase committees to increase organizationalorganizational (workplace) support (workplace) support for practicing healthy behaviors.for practicing healthy behaviors.

Intervention Planning: Choose Objectives Intervention Planning: Choose Objectives and Targetand Target

4. Provide assistance and support to 4. Provide assistance and support to a community advisory group for a community advisory group for addressing addressing community–widecommunity–wide health health and wellness issues.and wellness issues.

Intervention planning: identify mediators of Intervention planning: identify mediators of behavior change for blue collar womenbehavior change for blue collar women

1.1. Information and knowledge about health Information and knowledge about health behaviorsbehaviors

2.2. Practical strategies and skills practicePractical strategies and skills practice

3.3. Barriers and motivators (all levels)Barriers and motivators (all levels)

4.4. Stage of readiness to changeStage of readiness to change

5.5. Culture (attitudes)Culture (attitudes)

MATCHMATCH

Phase I: Goal SelectionPhase I: Goal Selection Phase II: Intervention PlanningPhase II: Intervention Planning Phase III: Program Phase III: Program

DevelopmentDevelopment Phase IV: Implementation Phase IV: Implementation Phase V: EvaluationPhase V: Evaluation

Formative Research for Intervention Formative Research for Intervention Planning & Program DevelopmentPlanning & Program Development

Focus groups (13) with women from each Focus groups (13) with women from each shift were used to determine:shift were used to determine:

Health priorities of womenHealth priorities of women How women support each otherHow women support each other Barriers to changeBarriers to change Facilitators for changeFacilitators for change Program implementation strategies (time, Program implementation strategies (time,

location)location) Women’s words for training manuals and tailored Women’s words for training manuals and tailored

messagesmessages

Baseline Health Surveys for Baseline Health Surveys for Intervention Planning and Program Intervention Planning and Program

DevelopmentDevelopment Demographic information (age, Demographic information (age,

weight, height, ethnicity/race, weight, height, ethnicity/race, children, etc.)children, etc.)

Health behaviors: exercise, diet, Health behaviors: exercise, diet, stress, smokingstress, smoking

Stage of readiness to changeStage of readiness to change BarriersBarriers Behavioral priorityBehavioral priority

Program Development: Create program Program Development: Create program componentscomponents

Tailored women’s magazines Tailored women’s magazines --2 magazines, 6 months apart--2 magazines, 6 months apart

--multiple health behaviors: diet, physical --multiple health behaviors: diet, physical activity, smoking, cancer screeningactivity, smoking, cancer screening

--feedback based on behavioral priority--feedback based on behavioral priority

--recipes, advice columns, personalized to --recipes, advice columns, personalized to individual and workplaceindividual and workplace

Program DevelopmentProgram Development::Create program Create program componentscomponents

Lay health advisor programsLay health advisor programs highly interactive training sessions highly interactive training sessions

for each health behavior as well as for each health behavior as well as social support and program social support and program maintenancemaintenance

training sessions fun, interactive, training sessions fun, interactive, provide information provide information andand skills skills practicepractice

Program DevelopmentProgram Development::Create program Create program componentscomponents

Employee Wellness Committees:Employee Wellness Committees: Representative of all job categories and Representative of all job categories and

ethnic groupsethnic groups Consultation and technical assistance from Consultation and technical assistance from

HWW/HWCHWW/HWC Choose a wellness or health issue based Choose a wellness or health issue based

on survey dataon survey data Implement a project to address that issue Implement a project to address that issue

with emphasis on organizational and with emphasis on organizational and environmental level changesenvironmental level changes

Program DevelopmentProgram Development::Create program Create program componentscomponents

Community Advisory Committee:Community Advisory Committee: Provides advice, consultation and direction to the Provides advice, consultation and direction to the

Center and HWW: key to participatory researchCenter and HWW: key to participatory research Members are from workplaces, local health Members are from workplaces, local health

departments, Healthy Carolinians, migrant-departments, Healthy Carolinians, migrant-community health center, domestic violence community health center, domestic violence agencies, cooperative extension, mental health, agencies, cooperative extension, mental health, dispute settlement center, and the state health dispute settlement center, and the state health dept.dept.

Chooses, plans, organizes and implements Chooses, plans, organizes and implements community-wide health and wellness activitiescommunity-wide health and wellness activities

MATCHMATCH

Phase I: Goal SelectionPhase I: Goal Selection Phase II: Intervention PlanningPhase II: Intervention Planning Phase III: Program DevelopmentPhase III: Program Development Phase IV: ImplementationPhase IV: Implementation Phase V: EvaluationPhase V: Evaluation

Plans and timelinesPlans and timelines

Production and distribution of tailored Production and distribution of tailored messagesmessages

Recruit LHA’s, develop materials and Recruit LHA’s, develop materials and training programstraining programs

Employee wellness committees: recruit Employee wellness committees: recruit members, develop session outlines and members, develop session outlines and strategiesstrategies

Community Advisory Committee: form Community Advisory Committee: form committee, develop plans and strategies committee, develop plans and strategies with the committeewith the committee

Implementation PreparationsImplementation Preparations

STEP 1: Develop implementation planSTEP 1: Develop implementation plan

Tailored messages: plans for distribution through Tailored messages: plans for distribution through workplace channelsworkplace channels

Natural helpers: recruit natural helpers and Natural helpers: recruit natural helpers and provide trainings (provide trainings (at the workplace, usually not at the workplace, usually not on work time)on work time)

Implementation PreparationsImplementation Preparations

Employee Wellness CommitteesEmployee Wellness Committees: work with : work with management contacts to recruit committee management contacts to recruit committee members representative of all members representative of all sections/employees; set first meeting and agendasections/employees; set first meeting and agenda

Community Advisory Committee: Community Advisory Committee: recruit recruit members based on formative work and previous members based on formative work and previous contacts; set first meeting and agendacontacts; set first meeting and agenda

Implementation PreparationsImplementation Preparations

STEP 2:STEP 2: Select and train staffSelect and train staff Include process evaluation and Include process evaluation and

feedbackfeedback

Employee Wellness Committee Employee Wellness Committee AccomplishmentsAccomplishments

Vending machine changesVending machine changes Canteen food options (fruit, yogurt, salads)Canteen food options (fruit, yogurt, salads) VCR in break roomVCR in break room Wellness bulletin boardsWellness bulletin boards Fundraising to build a walking trail Fundraising to build a walking trail Walking groupsWalking groups Work stretch breaksWork stretch breaks Health fairs and health screeningsHealth fairs and health screenings

Community Advisory Committee Community Advisory Committee ProjectsProjects

Women’s Empowerment Days:Women’s Empowerment Days: Planned and implemented by the Planned and implemented by the

Community Advisory CommitteeCommunity Advisory Committee Address health Address health andand economic needs economic needs

of blue collar womenof blue collar women Community-wide eventsCommunity-wide events New linkages among agenciesNew linkages among agencies

Lessons LearnedLessons Learned about intervention about intervention planning, program development and planning, program development and

implementation~implementation~

Plan WITH the participants: Plan WITH the participants: Formative research: ask, listen, and Formative research: ask, listen, and

useuse the data (qualitative and the data (qualitative and quantitative). quantitative).

Relationships are key, and take time.Relationships are key, and take time. Build on previous work and contacts.Build on previous work and contacts. Address unique barriers and Address unique barriers and

motivators.motivators.

Lessons LearnedLessons Learned about intervention about intervention planning,program development and planning,program development and

implementation~implementation~ Use the Socio-Ecologic model.Use the Socio-Ecologic model. Flexibility is important in planning. Flexibility is important in planning.

Be sure to allow for mid-course Be sure to allow for mid-course corrections.corrections.

Real-world problems Real-world problems WILLWILL occur; e.g, occur; e.g, manufacturing workplace manufacturing workplace constraints; economic and constraints; economic and community changes.community changes.

Lessons LearnedLessons Learned about intervention about intervention planning, program development and planning, program development and

implementation~implementation~

Health Works for Women/Health Works Health Works for Women/Health Works in the Community:in the Community:

A rewarding experience for the A rewarding experience for the researchers and the participantsresearchers and the participants

Contributions to practice and Contributions to practice and research; development of next research; development of next projectproject

HOPE Works (2004-2009)HOPE Works (2004-2009)

Builds on HWW-1 and HWW-2/HWCBuilds on HWW-1 and HWW-2/HWC Community-based participatory research Community-based participatory research

project, active participation of Community project, active participation of Community Advisory CommitteeAdvisory Committee

Addresses high prevalence of obesity…Addresses high prevalence of obesity… ……andand addresses social determinants of addresses social determinants of

health (education, employment, living health (education, employment, living situations)situations)

Modeled on loan circles/microenterpriseModeled on loan circles/microenterprise

Planning for HOPE Works Planning for HOPE Works (2003-2004)(2003-2004)

CAC women trained to lead focus CAC women trained to lead focus groups (8 focus groups conducted)groups (8 focus groups conducted)

CBPR Process/Committees formed:CBPR Process/Committees formed:• Facilitator trainingFacilitator training• MarketingMarketing• KickoffKickoff• Evaluation (baseline and community surveys)Evaluation (baseline and community surveys)

HOPE Works InterventionHOPE Works Intervention

HOPE CirclesHOPE Circles:: Low income, overweight women, African Low income, overweight women, African

American, Latina, Coharie, AngloAmerican, Latina, Coharie, Anglo Community women trained as facilitators Community women trained as facilitators

to lead Circlesto lead Circles Provide social support, strategies for Provide social support, strategies for

weight management, goal-setting for weight management, goal-setting for health and life improvement (school, jobs)health and life improvement (school, jobs)

HOPE Works InterventionHOPE Works Intervention

Monthly tailored messages on health Monthly tailored messages on health and life goalsand life goals

Community-wide events (walk-a-Community-wide events (walk-a-thon, kickoff/health fairs, connection thon, kickoff/health fairs, connection with community groups and events)with community groups and events)

Community Partner: MBA Community Partner: MBA (Multicultural Business Alliance)(Multicultural Business Alliance)

HOPE Works InterventionHOPE Works Intervention

Community CoordinatorsCommunity Coordinators Facilitator RecruitmentFacilitator Recruitment Facilitator TrainingFacilitator Training HOPE Circles: surveys and baseline HOPE Circles: surveys and baseline

data; comparison groupsdata; comparison groups

Seeds of HOPE Seeds of HOPE Threads of HOPEThreads of HOPE

Seeds: Using CBPR to address Seeds: Using CBPR to address economic empowerment: strategic economic empowerment: strategic planning yearplanning year

Seeds Circles: voter registration, Seeds Circles: voter registration, financial literacyfinancial literacy

Threads: formative work with Threads: formative work with Latina’s to pursue micro-enterpriseLatina’s to pursue micro-enterprise

Bumps (challenges and Bumps (challenges and opportunities!)opportunities!)

CBPRCBPR Staff changes; timelineStaff changes; timeline PAR QPAR Q First wave as pilot: flexibility to First wave as pilot: flexibility to

improveimprove Controls Controls

HOPE Works, August 2006HOPE Works, August 2006

3 Circle Leader trainings3 Circle Leader trainings

23 Circles complete or 23 Circles complete or ongoingongoing

Preliminary data: random Preliminary data: random community surveys (500)community surveys (500)

What do you believe is the single What do you believe is the single biggest issue facing your community biggest issue facing your community today?today?

Jobs and the economyJobs and the economy Drugs/alcoholDrugs/alcohol Social change/social capitalSocial change/social capital Poverty Poverty Hispanic immigrationHispanic immigration Cost of health care, prescriptionsCost of health care, prescriptions Environment (hog, poultry farms, landfill)Environment (hog, poultry farms, landfill)

““No jobs. Most of the factories are closingNo jobs. Most of the factories are closing—send the work overseas. If they keep —send the work overseas. If they keep this up no one will be able to buy their this up no one will be able to buy their products when it comes back to America products when it comes back to America because no one will have jobs. The gas because no one will have jobs. The gas prices have increased faster than the cost prices have increased faster than the cost of living increases in wages. Depression is of living increases in wages. Depression is hitting everyone because they cannot hitting everyone because they cannot afford what they’ve been having. No jobs, afford what they’ve been having. No jobs, no pay increase, but everything keeps no pay increase, but everything keeps going up. Yes everything was better years going up. Yes everything was better years ago. So obesity and health problems are ago. So obesity and health problems are on the rise. This problem will continue to on the rise. This problem will continue to increase as long as there is no jobs and increase as long as there is no jobs and depression from losing everything grows.”depression from losing everything grows.”

““In my community we don’t have anywhere In my community we don’t have anywhere for the children to go like a recreation for the children to go like a recreation center and its hardly any stores or center and its hardly any stores or restaurants where I live it’s a very small restaurants where I live it’s a very small town. Something about me I am 31 years town. Something about me I am 31 years old, single mother with asthma. I have 3 old, single mother with asthma. I have 3 children ages 10, 7 and 5. I would really children ages 10, 7 and 5. I would really like to lose weight for my health and to do like to lose weight for my health and to do more things with my children. I weigh more things with my children. I weigh about 300 pounds right now. And its hard about 300 pounds right now. And its hard for me to try and exercise because of my for me to try and exercise because of my asthma and then my breasts are real big.”asthma and then my breasts are real big.”