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Nutrition and Public Health Salli Benedict, MPH August 23, 2006

Intervention Planning, Program Development, and Implementation Health Works for Women/Health Works in the Community and HOPE Works. Nutrition and Public Health Salli Benedict, MPH August 23, 2006. Health Works for Women/Health Works in the Community and HOPE Works.

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Nutrition and Public Health Salli Benedict, MPH August 23, 2006

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  1. Intervention Planning, Program Development, and ImplementationHealth Works for Women/Health Works in the Community and HOPE Works Nutrition and Public Health Salli Benedict, MPH August 23, 2006

  2. Health Works for Women/Health Works in the Community and HOPE Works UNC Center for Health Promotion and Disease Prevention Centers for Disease Control and Prevention Funded Marci K. Campbell, PhD, RD, MPH Salli Benedict, MPH Leigh Belton, MA Margaret Bentley, PhD Ronni Bowen, PhD Brenda DeVellis, PhD Chantelle Fisher-Borne, MPH Elizabeth Hooten, PhD Kristine Kelsey, PhD

  3. Promoting the Health of Rural Blue Collar Women in the Workplace • Health Works for Women-1 (1993-1998) 9 manufacturing plants; healthy eating, physical activity, cancer screening, and smoking; 2 levels of socio-ecologic model

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

  5. Overall Goal: to reduce morbidity and mortality among low income working women in Eastern N.C. • Heart disease • Obesity • Cancer • Hypertension • Diabetes

  6. Improve health behaviors that contribute to leading causes of morbidity and mortality • Decrease smoking • Increase fruit and vegetable intake • Decrease dietary fat • Reduce stress levels • Increase physical activity

  7. Participant Characteristics (1166 women) • 68% overweight or obese • 6% eat 5 a day; 33% eat low fat • 25% exercise 3x week (with ADL & work) • 26% currently smoke; 38% live with smoker • 78% felt nervous/stressed most or some of the time in last month

  8. MATCH • Phase I: Goal Selection • Phase II:Intervention Planning • Phase III: Program Development • Phase IV: Implementation • Phase V: Evaluation

  9. Intervention Planning: select theory-based approaches • Individual ~ tailored health messages • Interpersonal ~ lay health advisor programs • Organizational ~ employee wellness committee projects • Community-societal ~ Community Advisory Committee projects

  10. Intervention Planning: Choose Objectives and Target 1. Provide health information and practical strategies to help individual female employees change unhealthy behaviors (nutrition, smoking, physical activity, weight management, and stress).

  11. Intervention Planning: Choose Objectives and Target 2. Provide information and practical strategies to groups of female employees for supporting co-workers in efforts to improve health behaviors.

  12. Intervention Planning: Choose Objectives and Target 3. Provide consulting and practical assistance to employee wellness committees to increase organizational (workplace) support for practicing healthy behaviors.

  13. Intervention Planning: Choose Objectives and Target 4. Provide assistance and support to a community advisory group for addressing community–wide health and wellness issues.

  14. Intervention planning: identify mediators of behavior change for blue collar women • Information and knowledge about health behaviors • Practical strategies and skills practice • Barriers and motivators (all levels) • Stage of readiness to change • Culture (attitudes)

  15. MATCH • Phase I: Goal Selection • Phase II: Intervention Planning • Phase III: Program Development • Phase IV: Implementation • Phase V: Evaluation

  16. Formative Research for Intervention Planning & Program Development Focus groups (13) with women from each shift were used to determine: • Health priorities of women • How women support each other • Barriers to change • Facilitators for change • Program implementation strategies (time, location) • Women’s words for training manuals and tailored messages

  17. Baseline Health Surveys for Intervention Planning and Program Development • Demographic information (age, weight, height, ethnicity/race, children, etc.) • Health behaviors: exercise, diet, stress, smoking • Stage of readiness to change • Barriers • Behavioral priority

  18. Program Development: Create program components • Tailored women’s magazines --2 magazines, 6 months apart --multiple health behaviors: diet, physical activity, smoking, cancer screening --feedback based on behavioral priority --recipes, advice columns, personalized to individual and workplace

  19. Program Development:Create program components Lay health advisor programs • highly interactive training sessions for each health behavior as well as social support and program maintenance • training sessions fun, interactive, provide information and skills practice

  20. Program Development:Create program components Employee Wellness Committees: • Representative of all job categories and ethnic groups • Consultation and technical assistance from HWW/HWC • Choose a wellness or health issue based on survey data • Implement a project to address that issue with emphasis on organizational and environmental level changes

  21. Program Development:Create program components Community Advisory Committee: • Provides advice, consultation and direction to the Center and HWW: key to participatory research • Members are from workplaces, local health departments, Healthy Carolinians, migrant-community health center, domestic violence agencies, cooperative extension, mental health, dispute settlement center, and the state health dept. • Chooses, plans, organizes and implements community-wide health and wellness activities

  22. MATCH • Phase I: Goal Selection • Phase II: Intervention Planning • Phase III: Program Development • Phase IV: Implementation • Phase V: Evaluation

  23. Plans and timelines • Production and distribution of tailored messages • Recruit LHA’s, develop materials and training programs • Employee wellness committees: recruit members, develop session outlines and strategies • Community Advisory Committee: form committee, develop plans and strategies with the committee

  24. Implementation Preparations STEP 1: Develop implementation plan • Tailored messages: plans for distribution through workplace channels • Natural helpers: recruit natural helpers and provide trainings (at the workplace, usually not on work time)

  25. Implementation Preparations • Employee Wellness Committees: work with management contacts to recruit committee members representative of all sections/employees; set first meeting and agenda • Community Advisory Committee: recruit members based on formative work and previous contacts; set first meeting and agenda

  26. Implementation Preparations • STEP 2: • Select and train staff • Include process evaluation and feedback

  27. Employee Wellness Committee Accomplishments • Vending machine changes • Canteen food options (fruit, yogurt, salads) • VCR in break room • Wellness bulletin boards • Fundraising to build a walking trail • Walking groups • Work stretch breaks • Health fairs and health screenings

  28. Community Advisory Committee Projects Women’s Empowerment Days: • Planned and implemented by the Community Advisory Committee • Address health and economic needs of blue collar women • Community-wide events • New linkages among agencies

  29. Lessons Learned about intervention planning, program development and implementation~ Plan WITH the participants: • Formative research: ask, listen, and use the data (qualitative and quantitative). • Relationships are key, and take time. • Build on previous work and contacts. • Address unique barriers and motivators.

  30. Lessons Learned about intervention planning,program development and implementation~ • Use the Socio-Ecologic model. • Flexibility is important in planning. Be sure to allow for mid-course corrections. • Real-world problems WILL occur; e.g, manufacturing workplace constraints; economic and community changes.

  31. Lessons Learned about intervention planning, program development and implementation~ Health Works for Women/Health Works in the Community: • A rewarding experience for the researchers and the participants • Contributions to practice and research; development of next project

  32. HOPE Works (2004-2009) • 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

  33. 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)

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