healthy weight in women of reproductive age action learning collaborative

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Healthy Weight in Women of Reproductive Age Action Learning Collaborative Salt Lake Valley/Utah Department of Health Team Audrey Stevenson, Iliana MacDonald

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Healthy Weight in Women of Reproductive Age Action Learning Collaborative. Salt Lake Valley/Utah Department of Health Team Audrey Stevenson, Iliana MacDonald. The Healthy Weight Action Learning Collaborative. - PowerPoint PPT Presentation

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Page 1: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Salt Lake Valley/Utah Department of Health Team

Audrey Stevenson, Iliana MacDonald

Page 2: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

The Healthy Weight ActionLearning Collaborative

• Aim to build state and local capacity to help women of reproductive age achieve healthy weight before, during, and after pregnancy

• Utah, one of eight states who applied for and was awarded the opportunity to participate in the ALC

Page 3: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Utah’s Team

Comprised of partners from:

• Utah Department of Health, • University of Utah Center Of

Excellence in Women’s Health• Salt Lake Valley Health Department• WIC Program staff; both state and

local offices

Page 4: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Healthy Weight in Women of Reproductive Age in

UtahAccording to 2005 Utah BRFSS Data

• 42.3% of reproductive aged women reported their BMI as overweight or obese

• 26.4% of reproductive aged women report eating 5 or more servings of fruits/vegetables per day

• 59.8% report meeting recommendations for moderate or vigorous physical activity

• 83.5% report having no leisure time activities in the past month

Page 5: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Healthy Weight in Women of Reproductive

Age in Utah

According to WIC PNSS, 2004

• 39.5% of women enrolled in WIC had an overweight/obese prepregnancy BMI –an increase of 30% since 1994

• Less than half of WIC enrollees are at a normal BMI prior to conception.

Page 6: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Healthy Weight in Women of Reproductive Age in

UtahAccording to 2004 Utah Vital Records data

• 34.7% of women with a live birth were overweight or obese before pregnancy

• An increase of 30% since 1994 • 67.5% of overweight/obese women

exceeded the Institute of Medicine’s recommendations for weight gain during pregnancy

Page 7: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Healthy Weight in Women of Reproductive Age in

UtahAccording to a recently published analysis

by LaCoursierre et al

• Among women who delivered via cesarean section, 1 in 7 is attributable to being overweight or obese prior to pregnancy

• Data also showed an increase in preeclampsia rates over the same interval

Am J Obstet Gynecol. 2005 Mar;192(3):832-9.

Page 8: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Healthy Weight in Women of Reproductive Age in

UtahRecent Utah PRAMS data found that women

who were obese prior to pregnancy were at increased risk of developing:

• diabetes or hypertension, • delivering a macrosomic infant,• having labor induced, • having their infant admitted to the

newborn intensive care unit,• reporting postpartum depression

Page 9: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Healthy Weight in Women of Reproductive Age in

UtahUtah PRAMS data also shows that

overweight and obese women were more likely to have:

• lower education levels, • to be multiparous, • to be below 200% of the federal

poverty level, and • to be enrolled in WIC during

pregnancy.

Page 10: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Healthy Weight in Women of Reproductive Age in

Utah

• An analysis of infant deaths in Utah from 1995 to 1998 due to perinatal conditions found that obese women had significantly higher rates of infant death when compared to normal weight women.

Page 11: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Utah’s Short-term goals

• Establishment of strong collaborative relationships among appropriate public health organizations and agencies to increase Utah’s capacity to help women of reproductive age achieve healthy weight before, during, and after pregnancy

Page 12: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Utah’s Short-term goals

• Development of a strategic plan which incorporates evidenced based and/or promising interventions to address the increasing prevalence of overweight/obesity among women of reproductive age in Utah

Page 13: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Utah’s Long-term (5-yrs plus) Vision

• Reversal of the increasing percentages of women with unhealthy pre-pregnancy weight and inappropriate weight gain during pregnancy by implementing system and program changes that impact weight status and weight retention among pregnant and lactating Utah women.

Page 14: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Utah’s Long term goals • Establishment of ongoing, sustainable collaboration

between key partners • Implementation and evaluation of promising interventions

in Salt Lake County WIC clinics to help women of reproductive age achieve healthy weight before, during, and after pregnancy

• Expansion of successful interventions to WIC clinics and other appropriate populations throughout Utah to help women of reproductive age achieve healthy weight before, during, and after pregnancy

• Implementation and evaluation of reproductive health care provider system changes e.g., provider education and tools to assist them in identifying high risk women and delivering a healthy weight message during provider visits

• Reversal of the trend of increasing rates of overweight/obesity among women of reproductive age in Utah

Page 15: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Next Steps

• Key informant surveys of WIC staff to ID barriers to counseling

• Focus groups (3-5) with pregnant, postpartum, interconceptional overweight and obese women to ID assets/barriers to healthy weight

• Chart reviews to ascertain provider practices r/t ID and addressing overweight/obesity during prenatal

• Bright Futures for Women’s Health and Wellness Program Implementation

Page 16: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Next Steps: Key Informant survey

• 25 surveys distributed, 23/25 = 92% return rate

• Dietitian/Nutrition Assistants Salt Lake County WIC clinics

Page 17: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Key Informant ResultsQuestion 1: What challenges do you face,

if any, in addressing healthy weight among the WIC clients you counsel?

Client based problems (attitudes, motivation level, and cultural views held by the client)

(17) 74%

Limitations due to the setup of the WIC clinic and/or program (inadequate follow-up and inadequate time in appointments with clients)

(9) 39%

General problems (language barrier, difficulty in addressing the issue, and MD telling client conflicting information about weight status)

(8) 35%

Page 18: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Key Informant ResultsQuestion 2: What training/education does WIC

need to provide to staff in order for you to adequately address healthy weight with WIC clients?

New approaches to counseling (new ideas, increasing client motivation, and exercises for pregnant women)

(10) 43%

Sensitivity training (5) 22%

New handouts (3) 13%

Time and money for nutritionists to go to weight management training outside of the county

(3) 13%

Other (3) 13%

Current training is adequate (2) 9%

Language training (1) 4%

Page 19: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Key Informant ResultsQuestion 3: Is the WIC program doing enough to address

healthy weight among clients? If not, what recommendations can you make that will help WIC improve in this area?

• Yes (10) 43%• No (12) 52%

Improvement in counseling methods and/or classes

(7) 30%

Improvement of resources for client use (training for nutritionists, healthy foods on WIC checks, training for nutritionists, handouts)

(4) 17%

County needs to change focus (goals on healthy weight for pregnant and postpartum women)

(3) 13%

Page 20: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Key Informant ResultsQuestion 4: What barriers prevent you

from discussing overweight/obesity issues with clients?

Client barriers (cultural, language, lack of motivation, and misconceptions)

11 (48%)

Barriers coming from the nutritionists (sensitive nature of counseling makes it difficult and client becomes defensive)

(11) 48%

Program barriers (inadequate time to address the issue, lack of follow up, inadequate teaching materials

(8) 35%

Other (1) 4%

Page 21: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Key Informant ResultsQuestion 5: In your opinion, do you feel

supported by community health care providers in addressing overweight/obesity issues?

Some respondents checked both yes and no on this item.

Yes (MD reports weight issue to clients) (15) 65%

No (MD downplays the weight issue) (14) 61%

Page 22: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Key Informant ResultsQuestion 6: How receptive are clients about

receiving healthy weight information?

Some respondents answered both positively and negatively for this question.

Depends on client perception of the problem-varies

(9) 39%

Receptive (9) 39%

Argumentative, defensive, or not receptive (5) 22%

Other (1) 4%

Page 23: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Key Informant ResultsQuestion 7: How comfortable are you in

discussing healthy weight issues? Please elaborate further on your answer.

Comfortable (17) 74%

Not comfortable (6) 26%

Nutritionist will gloss over weight issue/weight management counseling if the client does not have interest/acts defensive

(2) 9%

Page 24: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Key Informant ResultsQuestion 8: What resources is

WIC providing for clients that you use during counseling of healthy weight?Handouts (22) 96%

Other (classes, visual aids/food models, and height and weight graph)

(15) 65%

Referrals and/or information (exercise or county recreation centers)

(4) 17%

Page 25: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Key Informant ResultsQuestion 9: What additional resources

would be helpful to you during counseling?

More/different handouts (14) 61%

More/different visual aids (4) 17%

Videos (3) 13%

Other (2) 9%

Page 26: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Key Informant ResultsQuestion 10: What types of counseling strategies or

information do you usually discuss with clients when addressing the issue of healthy weight?

Discuss food intake (13) 57%

Discuss beverage intake (12) 52%

Activity level (12) 52%

Client driven goal setting (7) 30%

Other specific counseling strategies (24-hour recall, food triggers, family centered)

(7) 30%

Discuss long-term health problems with obesity (6) 26%

Use materials like Food Guide Pyramid and Growth Chart

(4) 17%

Page 27: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Key Informant ResultsQuestion 11: What types of counseling

techniques do you find to be most effective?

Other (24-hour recall, avoiding offensive terms, and addressing the issue, developing rapport, following up, assessing readiness, developing rapport, follow up for accountability, following VENA guidelines, teaching in the general classes)

(10) 43%

Client directed goal setting (8) 35%

Visual aids (7) 30%

Positive feedback (5) 22%

Specific food modifications (4) 17%

Asking open ended questions (3) 13%

Providing handouts (activity ideas) (2) 9%

Using growth charts or weight gain grids (2) 9%

Page 28: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Focus Groups

• Focus groups (3-5) with pregnant, postpartum, interconceptional overweight and obese women to ID assets/barriers to healthy weight

• Funding secured from Region VIII OWH to provide incentives, daycare and light healthy refreshments

• English and Spanish facilitators

Page 29: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Focus Groups

Discussion themes: • Explore knowledge/beliefs around

relationship between healthy weight and pregnancy outcomes

• Explore knowledge/beliefs around relationship between healthy weight and prevention of chronic disease

• Explore cultural beliefs/traditions/lifestyle issues that contribute to unhealthy weight

Page 30: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Focus Groups

• Explore knowledge/beliefs around importance of “5-a-day”

• Explore knowledge/beliefs around physical activity recommendations (@ least 30 min./day most days of week)

• Explore knowledge/beliefs about role of breastfeeding in maintaining a healthy weight

• Brainstorm interventions that would promote healthy weight

Page 31: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Chart review project

• Prenatal medical record review (University of Utah and SLVHD clinics) assessing: – Provider’s demographic info– Pre-pregnancy height and weight

recorded– BMI calculated – If BMI > 30, listed on problem list

Page 32: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Project Implementation

• The Bright Futures program will be implemented at two clinics (South Main Public Health Center, Ellis Shipp Public Health Center)

• Women who receive MCH services at these two sites also participate in WIC

• Project will be evaluated after one year

Page 33: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Bright Futures• My Bright Future: Physical Activity And Healthy

Eating Guide for Adult Women• Getting Started: Questions to answer on your own and talk

about with your health care provider.• Healthcare Provider: Ideas on how to start a conversation

with your health care provider and examples of questions you can ask.

• My Healthcare visit: Section for your health care provider to fill out during your visit.

• Setting My goals: Charts for setting goals with your health care provider (or on your own).

• What I Should Know: Information and ideas to help you reach your goals.

• Hints For Reaching My Goal: More ideas to help you meet your goals.

• Getting More Information: Other resources to help you.

Page 34: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

ABOUT THE BRIGHT FUTURES FOR WOMEN’S HEALTH AND WELLNESS INITIATIVE•The Bright Futures for Women’s Health and Wellness (BFWHW) initiative is a project of the U.S.•Department of Health and Human Services’ Health Resources and Services Administration (HRSA),Office of Women’s Health. •The mission of BFWHW is to plan, develop, implement, and evaluate a variety of culturally competent consumer, provider, and community-based products for all women across their lifespan—including underserved and minority women. •The Bright Futures materialshelp to promote women’s physical, emotional, social, and spiritual health and well-being.

Page 35: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Bright Futures

http://www.hrsa.gov/womenshealth/toolkit/menu.html

Page 36: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Challenges

• Focus group recruitment• Keeping partners engaged• Maintaining flexibility needed to

revise interventions• Acquiring incentive monies for focus

groups

Page 37: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Questions?

Page 38: Healthy Weight in Women of Reproductive Age Action Learning Collaborative

Contact information

[email protected][email protected]