Diverse Culturally-Based Community Organizations and Researchers Collaborating for Improved Health: An interactive discussion on how

Communities can Work Successfully with Researchers

A Community-Based Partnership to Reduce Health Disparities and Promote Wellness in Diverse Women:

The Coalition for a Healthier Community (CHC) for Utah Women and Girls (UWAG) on behalf of Community Faces of Utah and the Coalition

CHC- UWAG Partners• Community Faces of Utah

– Best of Africa

– Calvary Baptist Church

– Hispanic Health Care Task Force

– Urban Indian Center

– National Tongan American Society

– University of Utah (C/E Team of the CCTS)

– Utah Department of Health

• University of Utah (COEWH and UWHC)• Utah State University Extension Agents

Funding

• HHS Office on Women’s Health (OWH)

• Phase I: 1-year of funding for needs assessment and planning

• Phase II: 5-years of funding for implementation and evaluation of evidence-based intervention

Our intervention

• Community Wellness coaching program– Co-developed by UWAG team, CFU leaders, CCTS

using CBPR and Individualized goal setting– Motivational Interviewing: with individual goal

setting– Practical strategies for healthy eating and active

living– Group activities developed by each CFU community– Thinking holistically

• Coaches recruited by each community– English, Spanish, Kirundi-speaking

OUR STUDY DESIGN

• Randomized Trial– Participants recruited and coached by wellness

coaches from their own communities

• Is a COMMUNITY WELLNESS COACHING approach more effective in decreasing obesity risk factors when administered with monthly (high intensity) vs. 4 times per year (low intensity) contacts?

• If so, does the improvement warrant the additional costs?

Implementation• Questionnaire and protocols developed

• REDCap database developed– 3 languages– Coaching prompts

• CFU community leaders recruited community members to serve as coaches

• Coaches trained by UWAG staff– HIPAA, CITI– Wellness coaching– Data collection– REDCap

Data Collection• Community Wellness Coaches collect study

data– Relationship building is key!

• Interview questions about:– Health knowledge and behaviors– Perceived benefits and barriers– Social Support– Mental health

• Blood pressure, BMI, waist-to hip ratio measured

• Goals set and progress tracked

STUDY PROGRESS

• Goals: 400 women enrolled in the program: 80 per community– Completed Baseline Interviews: 500– Completed 4-Month Interviews: 351– Completed 8-Month Interviews: 308– Completed 12-Month Interviews: 239

• Findings at 12 months: 70% successful (or very successful with goals

• 8 months: improvement in depression prevalence

Increased fruit/vegetable consumption

Increased physical activity0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

57.6%

46.7%

62.1%

50.0%

67.8% 64.4%

Changes in Health Behaviors between Baseline and Follow-Up

Baseline to 4 Months Baseline to 8 Months Baseline to 12 Months

Lost 5% or more of baseline weight0%

10%

20%

30%

40%

50%

60%

70%

14%20% 22%

Changes in Weight between Baseline and Follow-Up:

1 in 5 women lost 5% of baseline weight by 12 months!

Baseline to 4 Months Baseline to 8 Months Baseline to 12 Months

Examples of Cost Effectiveness Ratio for Physical Activity Intervention Programs

Study Cost-Effectiveness RatioReger (2002) $14,286Lombard (1995) $27,373Linenger (1991) $28,548UWAG $29,146Jeffery (1998) $29,759Kriska (1986) $39,690Knowler (1992) $46,914Young (1996) $68,557

Source: Roux et al., 2008

LESSONS LEARNED

• Takes time to build relationships(5 year grant)

• Bidirectional learning in everything we do• Put your ego aside • Work together to solve problems• Need face to face, phone—don’t rely on

email• Information must go back to community• Collaborate on presentations, posters,

publications

Thanks TO:• Best of Africa

– Valentine Mukundente, Esperance Rugamwa

• Calvary Baptist Church– Pastor France A. Davis, Doriena Lee,

Patricia Otiede, Cathy Wolfsfeld

• Hispanic Health Care Task Force

– Sylvia Rickard; Dee Dee Labato, Jeannette Villalta, Natalie Gutierrezs, Ana Sanchez-Birkhead

• National Tongan American Society

– Fahina Tavake-Pasi, Ivoni Nash, Edris Netzler Aiono, Se Toki

• Urban Indian Center– Ed Napia, Penelope Pinnecoose

• Utah Department of Health

– Brenda Ralls– Kathryn Rowley– Kalynn Fillion

• University of Utah– Kathleen Digre—Co-PI– Sara Simonson – Co-PI– Leanne Johnston– Patricia Eisenman– Normal Waitzman– Cathleen Zick– Iris Buder– Janet Shaw– Michael Varner– Jenny Hoggard– Grant Sunada, Jamie Prevedel, Julia Webber

• CCTS– Heather Coulter – Stephen Alder – Louisa Stark– Bernie LaSalle