Best practices in implementing lifestyle interventions in the WISEWOMAN program: adaptable strategies for public health programs.

PURPOSE: Describe best practices for implementing a variety of lifestyle interventions targeting cardiovascular disease risk factors. APPROACH: A mixed-methods approach was used to collect and analyze data. The study was guided by the RE-AIM framework. SETTING: Selected Well-Integrated Screening and Intervention for Women Across the Nation (WISEWOMAN) projects funded by the Centers for Disease Control and Prevention. PARTICIPANTS: Five of the 15 currently operating WISEWOMAN projects were selected for study. Selection was based on availability of quantitative performance data, which were used to identify two high-performing and one low-performing sites within each project. METHOD: Qualitative data collection included a review of program materials; telephone interviews with federal, project, and local staff, and site visits. Site visits involved interviews with staff observations of the lifestyle intervention, and discussions with focus groups of participants. Analysis involved writing site reports, developing theme tables, identifying practices of interest, and applying an algorithm to identify best practices. RESULTS: Eighty-seven best practices were identified. We present a subset of 31 practices applicable to other public health programs and for which differences in how high- and low-performing sites used the practices were identified. DISCUSSION: Many of the best practices identified are applicable to broader audiences. Practitioners interested in strategies to recruit, engage, and retain participants and to facilitate behavior change can learn from these practices.

Identifying best practices for WISEWOMAN programs using a mixed-methods evaluation.

INTRODUCTION: Recommendations on best practices typically are drawn from unique settings; these practices are challenging to implement in programs already in operation. We describe an evaluation that identifies best practices in implementing lifestyle interventions in the Center for Disease Control and Prevention's WISEWOMAN program and discuss our lessons learned in using the approach. METHODS: We used a mixed-methods evaluation that integrated quantitative and qualitative inquiry. Five state or tribal WISEWOMAN projects were included in the study. The projects were selected on the basis of availability of quantitative program performance data, which were used to identify two high-performing and one low-performing site within each project. We collected qualitative data through interviews, observation, and focus groups so we could understand the practices and strategies used to select and implement the interventions. Data were analyzed in a multistep process that included summarization, identification of themes and practices of interest, and application of an algorithm. RESULTS: Pilot testing data collection methods allowed for critical revisions. Conducting preliminary interviews allowed for more in-depth interviews while on site. Observing the lifestyle intervention being administered was key to understanding the program. Conducting focus groups with participants helped to validate information from other sources and offered a more complete picture of the program. CONCLUSION: Using a mixed-methods evaluation minimized the weaknesses inherent in each method and improved the completeness and quality of data collected. A mixed-methods evaluation permits triangulation of data and is a promising strategy for identifying best practices.