Health promotion interventions for disadvantaged women: overview of the WISEWOMAN projects.

BACKGROUND: The Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program aims to remove racial and ethnic disparities in health by addressing the screening and intervention needs of midlife uninsured women. This paper describes the WISEWOMAN program requirements, the design of the 12 projects funded in 2002, the use of a standardized data reporting and analysis system, risk factors among participants, effective behavioral strategies, and plans for the future. METHODS: The WISEWOMAN demonstration projects are examining the feasibility and effectiveness of adding a cardiovascular disease (CVD) prevention component to the early detection of breast and cervical cancer. Women aged 40-64 are eligible if they are enrolled in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in selected U. S. states and are financially disadvantaged and lack health insurance. The primary outcome measures are blood pressure, lipid levels, and tobacco use. Intermediate measures include self-reported diet and physical activity, measures of readiness for change, and barriers to behavior change. RESULTS: During 2002, the 10 projects that were fully operational screened 8164 financially disadvantaged women and developed culturally and regionally appropriate nutrition and physical activity interventions for a variety of racial and ethnic backgrounds. Twenty-three percent of the women screened had high total cholesterol, with 48% of these being newly diagnosed. Thirty-eight percent of the women had high blood pressure, with 24% being newly diagnosed. Approximately, 75% of participants were either overweight or obese, and in some sites up to 42% were smokers. CONCLUSIONS: The WISEWOMAN demonstration projects have been successful at reaching financially disadvantaged and minority women who are at high risk for chronic diseases. These projects face challenges because they are generally implemented by safety net providers who have limited resources and staff to conduct research and evaluation. On the other hand, the findings from these projects will be especially informative in reducing health disparities because they are conducted in those settings where the most socially and medically vulnerable women receive care.

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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.