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 scoping review of maternal health among resettled refugee women in the United States.

Background: Globally, refugee women continue to face higher maternity-related risks from preventable complications during pregnancy and childbirth, partly due to high health care costs, unfamiliarity with the healthcare system, language barriers, and discrimination. Nevertheless, there is still a paucity of literature that evaluates the available evidence in the US. This scoping review delineated the body of literature on maternal health among refugee women resettled in the US in order to identify knowledge gaps in the literature and highlight future research priorities and directions for maternal health promotion. Methods: Electronic databases were searched in PubMed, CINAHL, PsycINFO, and EMBASE from inception through July 2021. We included all peer-reviewed study designs; qualitative, quantitative, and mixed method if they reported on refugee women's perinatal health experiences and outcomes in the US. Results: A total of 2,288 records were identified, with 29 articles meeting the inclusion criteria. Refugee women tend to initiate prenatal care late and have fewer prenatal care visits compared to women born in the US. Some of them were reluctant to get obstetric interventions such as labor induction and cesarean delivery. Despite numerous risk factors, refugee women had generally better maternal health outcomes. Studies have also highlighted the importance of health care providers' cultural competency and sensitivity, as well as the potential role of community health workers as a bridge between refugee women and health care providers. Conclusions: The scoping review emphasizes the need for early prenatal care initiation and more frequent prenatal care visits among refugee women. Furthermore, more needs to be done to mitigate resistance to obstetric interventions and mistrust. The mechanism by which healthy migrant effects occur could be better understood, allowing protective factors to be maintained throughout the resettlement and acculturation process. The scoping review identifies critical gaps in the literature, such as the underrepresentation of different ethnic groups of refugee women in refugee maternal studies in the US. Since this invisibility may indicate unspoken and unaddressed needs, more attention should be paid to underrepresented and understudied groups of refugee women in order to achieve health equity for all.

Food Bank-Based Diabetes Prevention Intervention to Address Food Security, Dietary Intake, and Physical Activity in a Food-Insecure Cohort at High Risk for Diabetes.

PURPOSE AND OBJECTIVES: Although food insecurity is associated with poor dietary intake and risk of chronic disease, few studies have demonstrated the effectiveness of diabetes prevention interventions delivered through food banks. Food banks serve vulnerable communities. The purpose of this pilot project was to assess the effectiveness of a food bank-delivered intervention aimed at improving food security and reducing risk factors for type 2 diabetes among at-risk clients. INTERVENTION APPROACH: We screened adult English- and Spanish-speaking food bank clients for type 2 diabetes risk at 12 community food distribution sites in Alameda County, California. Screening and enrollment for a pilot intervention took place from November 2017 to March 2018. Intervention components were delivered from November 2017 through March 2019. The intervention included monthly diabetes-appropriate food packages, text-based health education, and referrals to health care. EVALUATION METHODS: Food bank staff members administered surveys to participants at baseline, 6 months (midpoint), and 12 months (postintervention); participants self-reported all responses. Primary outcomes assessed were food security status, dietary intake, health-related behaviors, and body mass index (BMI). Information on demographic characteristics, food pantry access, health care use, and symptoms of depression was also collected. RESULTS: We screened 462 food bank clients for eligibility. Of the 299 who were eligible, 244 enrolled; 90.6% were female, 80.1% were Hispanic, and 49.1% had an annual household income less than $20,000. At baseline, 68.8% of participants had low or very low food security. At midpoint, participants had significant improvements in food security status, dietary intake, physical activity, health status, and depression scores. Mean BMI did not change. IMPLICATIONS FOR PUBLIC HEALTH: This intervention demonstrated that food banks can effectively screen clients at high risk for diabetes and improve household food security and other risk factors for diabetes. Food banks may be an important and strategic partner for health care systems or community-based organizations working to prevent diabetes in food-insecure populations.

Using the Infrastructure of State Aging Services to Promote Prevention Behavior.

INTRODUCTION: State infrastructure for aging services, such as programs in county senior centers, can help promote prevention of chronic disease and reach large numbers of older adults. The objective of our study was to assess how well such infrastructure can support prevention efforts. METHODS: The University of Pittsburgh CDC Prevention Research Center partnered with the Pennsylvania Department of Aging APPRISE program to deliver the 10 Keys to Healthy Aging program. APPRISE is a Medicare counseling program offered at senior centers; the 10 Keys is a series of behavior-activation workshops for people aged 50 or older that cover recommendations of the US Preventive Services Task Force and other evidence-based recommendations for health promotion. We assessed implementation, increases in prevention knowledge, and maintenance of prevention behavior. RESULTS: From 2013 through 2016, 1,534 adults at 83 sites participated in the program; 1,044 (68.1%) completed at least 8 of 10 Keys workshops. A total of 736 adults (mean [standard deviation] age, 74.9 [8.3] y) voluntarily completed a 14-item pretest and posttest of prevention knowledge; respondents' knowledge score increased from 61.5% to 78.5% correct (P < .001). In a subsample (n = 339) reporting on their own prevention behaviors at baseline, quiz scores and prevention behaviors were correlated (r = 0.30, P < .001). In monthly telephone follow-up with 147 respondents over 6 months, maintenance of prevention behaviors was strong in the areas of physical activity and hypertension management and significantly higher for people completing a greater number of Keys workshops. CONCLUSION: Prevention behavior can be activated in aging services settings and can be incorporated into daily routines.