Provider Counseling, Health Education, and Community Health Workers: The Arizona WISEWOMAN Project

Abstract

Background:The Arizona Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) project used provider counseling, health education, and community health workers (CHWs) to target chronic disease risk factors in uninsured, primarily Hispanic women over age 50.Methods: Participants were recruited from two Tucson clinics participating in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Women were randomly assigned into one of three intervention groups: (1) provider counseling, (2) provider counseling and health education, or (3) provider counseling, health education, and CHW support. At baseline and 12 months (1998-2000), participants were measured for height, weight, waist and hip circumference, and blood pressure. Blood tests were conducted to check blood glucose, cholesterol, and triglyceride levels. At each time point, participants also completed 24-hour dietary recalls and questionnaires focusing on their physical activity levels.Results: A total of 217 women participated in baseline and 12-month follow-up. Three fourths were Hispanic. All three intervention groups showed an increase in self-reported weekly minutes of moderate-to-vigorous physical activity, with no significant differences between the groups. Significantly more women who received the comprehensive intervention of provider counseling, health education, and CHW support progressed to eating five fruits and vegetables per day, compared with participants who received only provider counseling or provider counseling plus health education.Conclusions: All three interventions increased moderate-to-vigorous physical activity but not fruit and vegetable consumption. The intervention group with provider counseling, health education, and CHW support significantly increased the number of women meeting national recommendations for fruit and vegetable consumption. 547

Physical Activity as Primary Prevention to Address Cancer Disparities

“…Identify and widely disseminate information about diversity-targeted PA research resources that erode territorial disease-specific ''silos'' (eg, the African American Collaborative Obesity Research Network, 103 the 25 newly funded National Center for Minority Health and Health Disparities planning projects, 104 CDC-funded Racial and Ethnic Approaches to Community Health projects, [105][106][107][108][109][110][111][112][113][114] or the CDC-funded WISEWOMAN projects [115][116][117][118][119][120][121][122][123][124][125][126][127][128][129][130][131][132][133] ). Expand pipeline programs to cultivate ''cultural insider'' researchers, those able to integrate cultural contextual factors into research question development, hypothesis generation, intervention design and implementation, measure selection and evaluation to optimize cultural salience and, ultimately, intervention efficacy and effectiveness.…”

An evidence synthesis of qualitative and quantitative research on component intervention techniques, effectiveness, cost-effectiveness, equity and acceptability of different versions of health-related lifestyle advisor role in improving health.

“…80 Keyserling 2002 108,109 had two comparator groups: one received a clinic-based intervention with IC with a nutritionist and the other received minimal intervention consisting of mailed pamphlets only. Staten 2004 119 had two comparator groups: one received provider counselling and the other received provider counselling and health education. Elder 2006 95,96 had two comparator groups; one received tailored mailed print materials and the other received targeted mailed 'off-the-shelf ' materials.…”

“…In Anand 2007, 80 119 The rural or urban nature of the studies was not well defined in any of the studies but was probably rural in Anand 2007 80 (on the reservation) and probably urban in Staten 2004 119 (clinics in Tucson). In Anand 2007 80 the household structure was chosen to build upon the strength of family ties and promote healthy lifestyle role modelling.…”

“…The participants in Resnicow 2004 118 had access to church-wide health fairs, education sessions and cooking classes, and received one-toone lay counselling via two telephone calls. The participants in Staten 2004 119 received provider counselling, along with an individualised behaviour change prescription, two health education seminars and a monthly newsletter, while CHWs provided fortnightly telephone calls and organised bimonthly walks. The participants in 108,109 received one 60-minute and three 45-minute clinic-based counselling sessions with a nutritionist and 12 monthly telephone calls from a LA.…”

“…Two studies used peers with common personal experience from a shared community [African-American women with type 2 diabetes; 108,109 Hispanic women most of whom (five of the six) were over 50 years of age 119 ]. Staten 2004 119 gave no training to their CHWs, although four had been previously trained as CHWs to provide outreach, translation services and transportation. Two studies gave moderate levels of technical training 80,118 and one study gave intensive technical training.…”