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HOPE Works

HOPE Works. 2004-2009 Health, Opportunities, Partnerships and Empowerment. UNC Center for Health Promotion and Disease Prevention Alice Ammerman, DrPH, RD, Director. Marci K. Campbell, PhD, MPH, RD (PI) Salli Benedict, MPH, Project Director Katie Barnes Peggy Bentley, PhD

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HOPE Works

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  1. HOPE Works 2004-2009 Health, Opportunities, Partnerships and Empowerment

  2. UNC Center for Health Promotion and Disease PreventionAlice Ammerman, DrPH, RD, Director • Marci K. Campbell, PhD, MPH, RD (PI) • Salli Benedict, MPH, Project Director • Katie Barnes • Peggy Bentley, PhD • Brenda DeVellis, PhD • Andrea Meier, PhD • Kristine Kelsey, PhD • Chantelle Fisher-Borne, MPH • Beth Hooten, PhD

  3. The evolution of the Health Works projects from participation to empowerment Health Works for Women (HWW) 1993-1998 Work-site health promotion project focusing on individual risk factors (diet and exercise) and strengthening social support networks • Worksites included nine textile, apparel, and light manufacturing companies in Eastern North Carolina • Project employed traditional research methods, as well as formative research methods

  4. The evolution of Health Works: From participation to empowerment • Health Works for Women/Health Works in the Community (HWW/HWC) 1998-2003 • Scope of the project expanded to address organizational and community factors that impact health and well-being • Community Advisory Committee (CAC), consisting of workplace representatives, local agencies, advocacy groups, established to provide guidance and feedback • Plant closings and lay-offs occurred in the course of project implementation

  5. The evolution of the Health Works projects: From participation to empowerment • Health Works After the Flood (HWATF) 2000-2003 • In the wake of devastation wrought by Hurricane Floyd in 1999, CAC members and UNC initiated a project with CDC support to address stress and IPV in the months following the flooding • Composition of the CAC changes to include more community members, domestic violence and mental health agencies, more leadership rather than advice

  6. Priscilla Allen Katie Barnes, Chair Sharon Brown Tabatha Brewer Consuela Combs Darlene Leysath Dixon Anne Doolen Pamela Gonzalez Addie Hall Barbara Harris Katherine Hernandez Judy Johnson-Truitt Donna Kelly Mary Bea Kolbe Elizabeth Maynor Pastor Patricia Peterson (Co-chair) Imani Rivera Delphine Smith Community Advisory CommitteeOctober 2006

  7. Women’s Empowerment Days Community Advisory Committee Project 2003 In response to community concerns about the economic downturn and the need for grassroots development and empowerment efforts • Planned and implemented by the Community Advisory Committee • Address health and economic needs of blue collar women • Community-wide events • New linkages among agencies

  8. Community Partner: MBA (Multicultural Business Association)

  9. “Poverty is hazardous to women’s health”: The link between health and poverty • Considerable micro-level research suggests a strong relationship between individual health and income (i.e. poverty leads to lower health status) • Important findings include: • Income level is a more important predictor of health status than income change • Income level has a greater impact on the health status of poor than high-income individuals • Extended periods of time in poverty have a greater and more negative impact on health than occasional episodes of poverty Phipps, S.

  10. Loss of traditional industries in eastern NC • The manufacturing industry in the United States has experienced extensive economic restructuring in the past 30 years, primarily affecting rural areas in the Southeast. • Between 1997 and 2002, North Carolina lost 100,000 jobs in the textile industry and 70,000 jobs in the apparel industry. Hossfeld L, Legerton M, Keuster G. Kalishman J, Stogner S, Ramey J.

  11. HOPE Works • Builds on HWW-1 and HWW-2/HWC • Community-based participatory research project, active participation of Community Advisory Committee • Addresses high prevalence of obesity… • …and addresses social determinants of health (education, employment, living situations) • Modeled on loan circles/microenterprise

  12. HOPE Works Conceptual Model Intermediate Outcomes Health Determinants • Community level • Neighborhood resources • Opportunities for learning and developing capacity • Community development and employment opportunity • Community involvement,collective efficacy, social capital • Health and obesity prevention resources • Partnerships/linkages • Community factors • Employment • Housing • Economic systems • Education • Culture and history HOPE Works Intervention Health and Social Change Outcomes Obesity prevention Health promotion Empowerment HOPE • Environment factors • Built environment • Rurality • Flood damage • and recovery • Individual level • Goal achievement • Self-efficacy • Knowledge/awareness • Skills and capacity building • Social support • Health behavior changes • Individual factors • Socioeconomic • Language • Culture • Education • Family • Health status

  13. HOPE Works • Intervention expands to larger community, not just workplaces • Retain women’s health focus • Address link between health, poverty, and hope • Goal setting • Uses third world community development principles and models

  14. Planning for HOPE Works (2003-2004) • CAC women trained to lead focus groups (8 focus groups conducted) • CBPR Process/Committees formed: • Facilitator training • Marketing • Kickoff • Evaluation (baseline and community surveys)

  15. HOPE Works InterventionHOPE Circles • Low income, overweight women, multi-ethnic (African American, white, Latina, Coharie Tribe) • Circles led by trained leaders from the community • Experiential learning (fitness activities, ice breakers, healthy food) • Provide social support, information, strategies for health behavior change • Goal-setting in health and hope domains (e.g. getting education, jobs, housing, etc)

  16. Circle Leader Training • Friday evening, all day Saturday • Experiential: ice breakers, fitness activities (music), healthy food • Presentations on weight management, healthy eating, fitness, stress, economic empowerment • Goal setting: didactic and practice • Monthly meetings

  17. HOPE Works Intervention • Tailored newsletters (6) that address both health and hope-related issues and goals Community-wide events and interventions; new focus on advocacy

  18. Evaluation --250 women in HOPE circles vs. 250 comparison women • Individual change in weight, diet, PA, hope, self-efficacy, social support, community involvement, social capital, psychological and economic well-being --Comparison of HOPE Works counties with neighboring counties via random surveys (via mail) • Health behaviors, awareness, community involvement, social capital, hope

  19. Qualitative Evaluation of Circle Leaders • Personal life and health-related changes in Leaders • Interviews, photo voice • Formative: intervention adaptations

  20. Preliminary data: random community surveys* What do you believe is the single biggest issue facing your community today? • Jobs and the economy • Drugs/alcohol • Social change/social capital • Poverty • Hispanic immigration • Cost of health care, prescriptions • Environment (hog, poultry farms, landfill) *511 surveys: over 80% completed this question

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

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

  23. Preliminary analysis of random community surveys : Hope • Hope is significantly higher among women with more education and income, higher self-reported health, more healthy days/month (BRFSS), more positive perceptions of their community’s economic and social capital. • Hope higher among employed women

  24. Preliminary random survey analysis: Hope • Level of hope was not different by age or race • Level of hope and body mass index: there was significantly lower hope among more obese (controlling for age, race, and education)

  25. HOPE Works…? Will the HOPE Works intervention that links health promotion/obesity prevention with social support and economic education/empowerment result in positive health and hope outcomes for women?

  26. Seeds of HOPE Goal: to create a sustainable model • Born of growing interest in the importance of economic empowerment to women’s health and community development • Opportunities, training, education, resources for enhancing economic empowerment and community wealth • Community-led partnership w/UNC, CDC, business and entrepreneurial organizations: one-year participatory strategic planning process

  27. Seeds of HOPE Partners • UNC (Jim Johnson, Anita Brown Graham, Jesse White) • Community (community colleges, economic development agencies) • Good Work • NC Rural Center • NCSU College of Design and Textile School

  28. Seeds of HOPE Strategic Plan Goals • Start a business that will serve as an example of an exemplary worker-owned business • Increase financial education across all HOPE Works activities • Increase networking with organizations that support entrepreneurial activities

  29. Threads of HOPE: Creation of a Woman-owned Business The Seeds of HOPE strategic plan: to create Threads of HOPE Build on skills of unemployed textile/apparel workers Unique design or product to reflect HOPE Works values, place and culture Collaboration with NCSU College of Design (and Penelope Bags?)

  30. Threads of HOPE Goals • Training for low income women in every aspect of running a business • Worker owned • Living wage • Health benefits • Health promoting business/HOPE Circles • Leadership development • Opportunity to pursue educational goals

  31. Threads of HOPE Activities • Collaboration with NCSU School of Textile and College of Design • Student contest: unique Threads of HOPE design • Meetings with community women • Ms. Tuggle’s Draperies • Contract with PRC Annual meeting

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