The Power of Tailoring a Government-Funded Heart Health Program for Marginalized Women: Lessons from WISEWOMAN and Mujer Poderosa/Powerful Woman.

The Centers for Disease Control and Prevention's DP18-1816 Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) award to the Pennsylvania Department of Health combats the leading cause of death in Pennsylvania, cardiovascular disease. Pennsylvania's program (PA-WISE) includes an innovative approach to engage low-income women in cardiovascular disease prevention. PA-WISE collaborated with Latino Connection to pilot Mujer Poderosa/Powerful Woman (MP/PW), utilizing bilingual community health workers to engage, educate, and empower marginalized women to improve their health. Latino Connection discovered different approaches were needed by each community for engaging women and connecting with resources. MP/PW tailored outreach and intervention approaches to women's needs and expectations, responding to differences in education levels, acculturation, immigration status, and levels of trust. The experiences of MP/PW provide lessons on the importance of having and maintaining flexibility in responding to women's backgrounds and community characteristics and tailoring to meet the needs of marginalized women.

Critical Lessons in Tailoring Interventions: Listening to WISEWOMAN Participants.

PURPOSE: To explore perspectives of participants in the WISEWOMAN program in Pennsylvania (PA-WISE) on challenges and facilitators of reducing cardiovascular disease risk as low-income and un-/under-insured middle-aged women. APPROACH: Researchers conducted this 2 year qualitative data collection as one component of a broader, 5 year PA-WISE process and outcome evaluation. SETTING: Women from across Pennsylvania, primarily from rural communities. PARTICIPANTS: Interviewees were low-income, un-/under-insured women aged 40-64 years who had recently participated in PA-WISE-facilitated health coaching and lifestyle programs (HC/LSPs). METHODS ­ DATA COLLECTION AND ANALYSIS: Researchers conducted individual telephone interviews with 38 women from four discrete samples of PA-WISE participants at 4 time points. Three researchers used grounded theory, and an iterative process of line-by-line coding, data display, and reanalysis to identify emerging themes, sub-themes, and their relationships. RESULTS: Participants shared the important benefits of specific PA-WISE program traits. However, participants described significant financial constraints, difficult schedules, caregiving responsibilities, and insufficient social support as persistent challenges in their lives, making lifestyle changes in general, and program participation specifically, difficult. CONCLUSION: The challenges that low-income and un-/under-insured women identified amplify the importance of having interventions that offer flexibility, options, and tailoring of supports and resources. The timeless challenges articulated by participants in this study completed just before the COVID-19 pandemic, remain relevant to be addressed through the pandemic and beyond.

A public health training center experience: professional continuing education at schools of public health.

The Public Health Training Center (PHTC) national program was first established at accredited schools of public health in 2000. The PHTC program used the US Health Resources and Services Administration's grants to build workforce development programs, attracting schools as training providers and the workforce as training clients. This article is a reflection on the experience of two schools, whose partnership supported one of the PHTCs, for the purpose of opening a conversation about the future of continuing education throughout schools and degree programs of public health. This partnership, the Pennsylvania & Ohio Public Health Training Center (POPHTC), concentrated its funding on more intensive training of public healthcare workers through a relatively narrow inventory of courses that were delivered typically in-person rather than by distance-learning technologies. This approach responded to the assessed needs and preferences of the POPHTC's workforce population. POPHTC's experience may not be typical among the PHTCs nationally, but the collective experience of all PHTCs is instructive to schools of public health as they work to meet an increasing demand for continuing education from the public health workforce.

Evaluating workforce development: perspectives, processes, and lessons learned.

Evaluating workforce development for public health is a high priority for federal funders, public health agencies, trainees, trainers, and academic researchers. But each of these stakeholders has a different set of interests. Thus, the evolving science of training evaluation in the public health sector is being pulled simultaneously in a number of different directions, each emphasizing different methods, indicators, data-collection instruments, and reporting priorities. We pilot-tested the evaluation of a 30-hour, competency-based training course in a large urban health department. The evaluation processes included strategic, baseline assessment of organizational capacity by the agency; demographic data on trainees as required by the funder; a pre- and posttraining inventory of beliefs and attitudes followed by a posttraining trainee satisfaction survey as required by the trainers and the agency; and a 9-month posttraining follow-up survey and discussion of learning usefulness and organizational impact as desired by the academic researchers and the trainers. Routinely requiring all of these processes in training programs would be overly burdensome, time-consuming, and expensive. This pilot experience offers some important practical lessons for training evaluations in the future.

Supporting academic public health practice: a survey of organizational structures in public health schools.

A survey was conducted at 28 schools of public health to assess how they allocate responsibility for three kinds of academic practice activity: continuing education, student internships, and technical consultation by faculty. Respondents identified whether these responsibilities were in a central practice unit, in another schoolwide unit, dispersed among several units, or dispersed among individual faculty members. Though all respondents engaged in these activities, responsibility tended to be carried out by individual departments or independent faculty members. This typically decentralized approach raises questions about the sustainability of academic public health practice that call for further inquiry.