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Open Minds &

Healthy Hearts
Reducing Cardiovascular Disease one
woman at a time!
Natasha Dang
Esha Fletcher

RFP
#3

Proposals are being solicited for developing, delivering, and


evaluating programs to reduce CVD mortality and morbidity
among high-risk women through medical screening and risk
behavior modifications. The CVD prevention programs must be
targeted towards high-risk racial and ethnic minority women,
aged 40 years and older; however, all high-risk women shall be
eligible to participate in the programs regardless of race,
religion or age. Each grantee shall propose to implement one
program in 10 faith-based or community-based sites across
Connecticut, including urban and rural areas. The main goal will
be for program participants to increase their level of physical
activity and establish or maintain a healthy weight over the

Healthy People
Overarching Goal:2020
Improve cardiovascular health
and quality of life through prevention, detection,
and treatment of risk factors for heart attack and
stroke; early identification and treatment of heart
attacks and strokes; and prevention of repeat
cardiovascular events.

Mission
Statement
The Open Minds and Healthy Heart Programs in
Connecticut are committed to providing quality,
cardiovascular-related preventative services to
minority women and their families. Our
dedicated team of professionals strive to
provide the community with knowledge and
resources, along with instilling confidence and
motivation to pursue a holistically healthy life.

Program Goals

1. Lower the prevalence of risk factors for Cardiovascular disease (CVD)


among high-risk minority women
2. Reduce the incidence of heart disease in Connecticut
3. Reduce hospitalization rates for minority women as a result of heartdisease related conditions
4. Reduce health disparities among races or ethnicities
5. Increase overall awareness of Cardiovascular disease, as well as
levels of both physical activity and self-efficacy among high-risk
ethnic women throughout the duration of the interventions
6. Increase knowledge and awareness of high-risk ethnic women on the
benefits of proper diet throughout the duration of the interventions

Mind Body & Soul


Educating the Mind, Exercising the Body &
Nourishing the Soul
Esha Fletcher

Background
Few unsettling stats:
CVD kills nearly 50,000 African-American
women annually
Of African-American women ages 20 and
older, 49% have heart diseases
Only 1 in 5 African-American women
believes she is personally at risk
Only 52% percent of African-American
women are aware of the signs and
symptoms of a heart attack

Program
Objectives

1. Short-term- Within the first month, get participants to make small


changes such as changing one bad eating habit

2. Short-term- Increase physical activity to at least one hour a week


outside of the program

3. Intermediate- Look for 90% participation every week during the


meetings

4. Intermediate- 70% improvement in the percent of participants


performing average or better for the cardiovascular step test

5. Long-term- Reduce 5% body fat in all participants

6. Long-term- Reduce the risk factors of CVD in 95% of the


participants that were active in participation over the 16 weeks

Goal-Setting
Theory

Five Principles:
Clarity, Challenge, Commitment, Feedback,
Task Complexity
The goal setting theory will be pushed
because it challenges the participants to set
meaningful and challenging goals. Dr. Edwin
Locke, the creator of the goal setting theory
found that setting clear goals and giving
feedback, motivates people.

Concept

Definition

Application

Clarity

Make clear goals so its known what you are trying


to achieve and what behaviors to reward. Does
the challenge motivate you?

Have participants write SMART goals on physical


activity, diet and nutrition throughout program

Challenge

Make goals challenging and motivating but


achievable. Develop self-discipline and have
persistence. Is it challenging enough to spark
interest?

Coach participants to make strong goals with


milestones to challenge themselves. Create friendly
competition b/w groups or prayer partners.
Competition can encourage participants to work
harder

Commitment

Being dedicated to a cause or activity.


Commitment can be gained if person believes the
goal is achievable and it follows their ambition

Participant more likely to stay committed if they


understand and agree to goal. Creates commitment
and sense of empowerment

Feedback

Listening to feedback at each milestone and


having opportunity to clarify expectations and
adjust goals if necessary.Feedback can also be
done by measuring your own progress.

Scheduling time each week to give participants


feedback by analyzing their progress and
accomplishments, while making adjustments along
the way

Task Complexity

Checking to ensure work doesnt become too


overwhelming when goals are highly complex.
Give self plenty of time to accomplish goals and
deadlines

Giving everyone training needs assessment, to


identify any knowledge or skills gaps

Health Belief
Model

Concept

Definition

Application

Perceived
Susceptibility

Ones opinion of chances of


getting a condition

Have participants take a poll on how


many people they think have CVD, give
them statistics and risk factors

Perceived
Severity

Ones opinion of how serious a


condition and its consequences
are

Symptoms, effects, polling results. How


many do you know people that died from
disease? Does it affect one race more
than another?

Perceived
Benefits

Ones belief in the efficacy of the


advised action to reduce risk or
seriousness of impact

Discuss success stories, benefits of


program, weight loss, how life would
change after the lifestyle changes have
been made

Perceived
Barriers

Ones opinion of the tangible


and psychological costs of the
advised action

Tackle the I cant do it thoughts, explain


its not a sprint its a marathon, can be
done but takes time and dedication

Cues to Action

Strategies to activate
readiness

Meetings, getting involved, using theory,


making personal connections, working
one-on-one and showing youre invested

Self-Efficacy

Confidence in ones ability to

Discuss with them the importance of

Explanation Plan

Process
3 year program
Held in churches (6 intervention, 4 control)
16-week intervention (3 in a year)= 2 years of interventions
Intervention groups meet twice/week
90 mins sessions- weekly educational topic, homework
assignments, 30 mins physical activity, devotional, weekly scripture
and discussion
Lottery, drawings and prize giveaways
Weekly checking of vitals
Weekly emails sent out to remind participants to exercise & work w/
prayer partners
Lessons on signs and symptoms of CVD

Design &
Measurement
Tools

Design

Year 1: 6 months: Planning, funding


approval, training health professionals, IRB
consent forms, rolling recruitment, focus
groups, randomly assign intervention and
control groups, marketing
6 months: Start of intervention, data
collection, participant consent forms
Year 2: Continue intervention and rolling
recruitment
Year 3: 6 months: Continue intervention
6 months: Data analysis, follow-up, program
evaluation, phone surveys

Tools

Baseline Assessment: height, weight,


blood pressure, BMI, % body fat
Resistance Bands
Pedometers
Cardiovascular fitness step test
Scales
Skin fold calipers
CPR equipment

Weekly Meetings
Overview
Weekly Topics

Food basics (carbs, fats, protein)


Reading food labels
Understanding Serving Sizes
DASH diet & guidelines
Meal Planning
Incorporating Fruits & Vegetables
Cultural Eating Habits
Holiday Survival Guide
Food Journaling
Readiness to Change:
Pedometers
Reducing & Lowering Risk Factors
Integrating Nutrition Knowledge

Weekly Handouts

Spiritual scriptures w/ buddy


Heart-Healthy Recipes
Choosing Foods at Grocery
Stores
Snacks & Eating on the Go
CVD Signs & Symptoms
CPR Training
Heart-Healthy Exercise
Heart-Healthy Cooking Tips for
Family
Women CVD Facts
Nutrition Flashcards
Walking Challenge
Extreme Food Makeover
Healthy Dining Out

Program Budget
Staff
Esha- $65,000/yr
Andrea- $65,000/yr
Natasha- $65,000/yr
Nurse- $40/hr
Dietitian- $30/hr
Recruitment/Marketing
Flyers, Newspaper, Radio- $100
Materials
Pedometers- $1.50 each
sheet
Resistance Bands- $9 each
sheet
Food Journals- $5 each
Posters/Visuals- $16
Biometric Screenings
Health Screenings- $25
Other
Cooking Classes (food, utensils)- $90/week

Data Analyst- $13/hr


Snap Educators- $19/hr
Fitness Specialist- $50/hr
Kickboxing- $40/hr
Zumba/Aerobics- $40/hr

Nutrition Education Materials- $0.02/


Surveys, Questionnaires- $0.02/
Lottery, Drawings, Prizes- $20/week

Skin Fold Calipers- $25 (5)

Marketing
Social Media- Facebook, Twitter, Instagram,
Blog
Church Bulletin- every Sunday
YWCA (Young Women's Christian Association)
Newspaper
Doctors
Church Website

Sources of
Funding

American Heart Association- Go Red Campaign


CDC:
National Implementation and Dissemination for Chronic Disease Prevention
(CDC-RFA-DP14-1418

NIH: Self-management for Health in Chronic Conditions


YWCA
Private Donors
Local Churches

One
Love,
One
Heart

Natasha Dang

Program
Rationale
CVD is the #1 killer on the top ten leading causes

of death for women in the U.S.


Attributed to lower awareness/education and
higher prevalence of risk factors/atypical
symptoms
Higher mortality/morbidity rates from CVD
2003 Survey Determined a knowledge deficit for
heart disease
5 major risks
Ethnic minority women most at risk
CVD modifiable through lifestyle changes

The Intervention
To reduce the risk of CVD
of high-risk minority
women by increasing
physical activity and
prolonging the
maintenance a healthy
weight through
community-based sites

Trans-Theoretical
Model
Stages of change
All participant volunteers at contemplative stage
or higher
Material tailored to each participant
Studies show that it is time consuming, but
effective

MATCH Model
Phase 6
Health
Status
(Morbidity
,
Mortality,
&
Wellness)
Phase 5
Evaluation

Phase 1
Health
Goal
Selection

Phase 4
Implementa
tion

Phase 2
Interventi
on
Planning
Phase 3
Developm
ent

Phase 1: Health Goal


Selection

Overarching goals:
awareness and knowledge of PA and diet,
prevalence of risk factors and CVD, and mortality &
morbidity from CVD, maintenance of weight loss
Priority population:
High-risk, postmenopausal, minority women of lowsocioeconomic status
Behaviors/Environmental Factors associated with
Time restraints
current health status:
Safety Concern
High salt/fat/sugar intake in diet
Lack of transportation
Smoking
Obesity
Physical Inactivity

Phase 2: Intervention
Planning
Target of intervention actions:
Individual Level: Behavioral change influences actions
or habits
Organizational Level: Members of a community are
influenced by their organizational leaders and residents
Community Level: Individuals learn by practices and
norms in the community
Intervention Actions:
Morbidity, mortality, and wellness are changed by the
use of facilitation, activities, resources, practices, and
education

Program Objectives
At the end of the program:
At least 90% of the participants will have increased
awareness for the risk factors of heart disease
At least 50% of the program volunteers will participate in
monthly health screenings.
There will less than a 30% attrition rate
The number of participants who integrate an exercise
routine into their daily life will be statistically significant (p
<0.05)
Health screenings post-intervention will determine that at
least 20% of the participants will be less at risk for CVD

Program Objectives
At the end of the program:
100% of all participants will have learned at least one
cooking skill that can be used daily
At least 20% of the participants will eat a diet with less fat
content from the start at baseline
At least 80% of the participants will complete the posttest

Phase 3: Program
Development
Program Components:
STEP 1

STEP 2

STEP 3

STEP 4

January 1st
2015
July 1st 2015

July 2nd 2015


October 1st
2015

October 2nd
2015
January 1st
2016

January 2nd
2016
July 1st 2017

6 Month
Interval

3 Month Interval

3 Month Interval

18 Month
Interval

Program
Planning,

Community
Counseling

Maintenance
Sessions

Program
Evaluation

Phase 3: Program
Development

Proposed Intervention Setting:


The program will be directed towards the New Haven
County in CT
Highest poverty rates
High rate of obesity
Proposed Intervention Approach:
Community Organizations
Center for Black Womens Wellness
Ct Chapter, Mocha Moms
Alpha Kappa Alpha Sorority, Inc. (AKA)
African American Cultural Society

Phase 4:
Implementation

Supportive Evidence:
Participants view positive support from others and
active opposition to cultural norms as critical for
maintenance
Strategies are set in place to maintain lost weight if
participants struggle
Focus groups aided maintenance of healthy weight
Strategies:
Multifaceted approach to intervention
Medically Trained Personnel
Social media and social support

Evaluation Plan
Process:
ROI: $5.60 for every dollar spent over five years
Treatment costs much higher than implementing a
health promotion program
Satisfaction Ratings by participants
Summative:
A questionnaire or survey is used to measure
knowledge/awareness of CVD related risk factors via
posttest
Post intervention health screening to identify the same
risk factors from baseline
Outcome Evaluation:
A questionnaire will be administered at a 5-year and

Program Design
STEP 1

STEP 2

STEP 3

STEP 4

6 Month Interval

3 Month Interval

3 Month Interval

18 Month Interval

Program Planning,
Development, and
Recruitment

Community
Counseling Sessions

Maintenance Sessions

Program Evaluation
and Write-Up

IRB Consent form,


Training
professionals,
Marketing and
advertisements,
Data Analysis,
Funding Approval,
Seminar Designs

Lectures, cooking
classes, lowmoderate physical
activity, health
demonstrations,
videos, field trips to
grocery stores,
fitness centers,
restaurants, tracking
food intake

Focus groups, social Data Analysis, followsupport, social media,


up, program
low-moderate
evaluation submitted
physical activity

Measurement Tools
Anthropometric Data [Scales, BP cuff,
measurement tape]
Height, weight, waist circumference, BMI, BP
Biochemical Data [Lab Reports]
Lipid panels (blood cholesterol), Metabolic
panels (sodium)
Surveys/Questionnaires before, during, and after
intervention (follow-up)
Reports from focus groups and social media
Cooking equipment

Abridged Financial
Budget

Marketing Strategies
1. E-mail
2. Formal Letters to Org.
leaders
3. Social Media
a. Facebook
b. Instagram
4. Program Website
5. Advertisements to the public
(newspapers, online)

Funding Opportunities
1. The Myocarditis Foundation
Supports an investigator proposing innovative basic, clinical or
translational research projects relevant to the etiology,
pathophysiology, diagnosis, treatment epidemiology and/or
prevention of myocarditis [CHF].
2. The American Heart Association
Research broadly related to cardiovascular function and
disease and stroke, or to related clinical, basic science,
bioengineering or biotechnology, and public health problems,
including multidisciplinary efforts.

Funding Opportunities
3. Centers for Disease Control & Prevention
This FOA will support effective implementation of existing
policy, systems and environmental improvements, and offers
opportunities for communities to take comprehensive action to
address risk factors contributing to the most common and
debilitating chronic conditions. These risk factors include
tobacco use and exposure, poor nutrition, physical inactivity,
and lack of access to chronic disease prevention, risk
reduction and management opportunities.
4. Prevention and Public Health Funds
This Funding Opportunity Announcement (FOA) supports
implementation of population-wide and priority population

References

Introduction to Evidence-Based Practice.


(2014, September 5). Retrieved
October 16, 2014, from
http://guides.mclibrary.duke.edu/content
.php?pid=431451&sid=353 0453.
RACIAL AND ETHNIC APPROACHES TO
COMMUNITY HEALTH (REACH). (2014,

Questions?

Heal and Soul

Andrea DePetris

Program Goals
1. Increase awareness and knowledge of CVD among
parishioners throughout CT
2. Lower CVD risk profiles of parishioners
3. Increase overall levels of physical activity (PA) among
parishioners
4. Increase levels of motivation and self-efficacy among
participants
5. increase knowledge about nutrition and healthy eating

Program Objectives
1. 90% of participants in the active intervention groups will attend at least one
of the two weekly sessions.
2. 100% of participants in the active intervention groups will participate in the
angel motivation for walking program.
3. There will be significant, positive improvements of at least 3 of the 13 CVD
physiological outcomes for at least 60% of participants in the active
intervention group
(weight, BMI, waist circumference, body fat %, SBP, DBP, LDL-C, energy
intake,
4. At least 60% of participants with a BMI 25 will lose 5% of their body weight
by the end of the 16 week standard intervention.
5. Reported levels of self-efficacy for physical activity will improve for 100% of
participants
6. 95% of participants in the active intervention sessions will fill out satisfaction
surveys after each session

Bopp et. al 2009; Dodani and Fields 2010; Yanek et al. 2001)

Behavior Theory
Social Cognitive Theory
- Interpersonal level theory
- Reinforcement
- direct reinforcement (ex: verbal praise, weight loss, increased
energy levels)
- vicarious reinforcement (ex: family spotlight, angels)
- self-reinforcement (ex: returning walking logs and increasing
steps, healthy treat/ activity, lottery entry)
- Self-efficacy
- performance attainment (ex: skill building & exercise mastery)
- vicarious experiences (ex: observing peers, church leaders,
exemplars)
- verbal persuasion (ex: peers, angels, PT, educators, church
leaders)
- emotional arousal (ex: interpreting ones emotional state with
(McKenzie, PT)
Neiger, and Thackery 2009)

Planning Model 1
Health Belief Model
-

Value expectancy theory


Health-related action depends on the simultaneous
occurrence of:
- existence of sufficient motivation (or health concern) to
make health issues salient/ relevant
- perceived threat (belief that one is vulnerable)
- belief that following a particular health recommendation
would be beneficial to reducing perceived threat at an
acceptable cost
Recognizes self-efficacy as a perceived barrier

(McKenzie, Neiger, and Thackery 2009)

Planning Model: Health


Belief Model

http://en.wikipedia.org/wiki/File:The_Health_Belief_Model.pdf

Planning Model 2
PRECEDE-PROCEED Model
-

outlines the steps which precede an intervention and


provides guidance on how to proceed with implementation
evaluation
participatory process involving all stakeholders
health is a community issue

(McKenzie, Neiger, and Thackery 2009)

PRECEDE

PROCEED

Evaluation Plan: Process


-

Focus groups and pilot testing in both an urban and rural


area of Connecticut
Focus groups assembled prior to implementation, at the end
of month 2, at the end of month 4, and after 12 months
Paper surveys will be collected after the PA portion of each
bi-weekly meeting (before dinner and nutrition segment)
In-depth interviews with church leaders and lay participants
Informal interviews will be on-going
Protocol checklists (fidelity)

Evaluation Plan: Summative


-

Regression analyses will be used to assess for trends and


significance in changes in CVD risk profiles, self-efficacy for
PA, social support for PA, weight loss (lbs and %), changes
in both physical activity and nutrition, physical activity
enjoyment, depression, and general health status
Prevalence of CVD/ CVD risk post-intervention will be
assessed, as well as knowledge about CVD

Program Design

(Prior to year one, obtain IRB approval from UConn)

Year 1:
establish community expert panels, obtain informed consent, focus groups, pilot intervention in both a rural
and urban setting
cluster large, active churches in CT by region & select participating churches randomly
randomly assign churches to intervention (6) and comparison groups (4)
Year 2:
Intervention and Comparison groups
health fair (screening, baseline data collection)
one day church retreats (small groups going to stations): motivational sessions, intro. to nutritional
education, intro to PA, focus groups, light yoga, massage, review of results from baseline screenings with
nutritionist, discussion of barriers to PA, intro. to angel program and angel pairings
handout pedometers: collect one weeks worth of data
Year 3: (3 months)
health fair and data collection, focus groups, interviews, fidelity checklists, analysis of results

health fair and data collection, focus groups, interviews, fidelity checklist

Sample Presentation Topics


Nutrition:
spirituality and health, creating a healthy environment, strategies for
overcoming barriers related to healthy eating, reading food labels,
planning healthy meals, modifying recipes, stress reduction, portion
size, grains and fiber, why we eat, meats & meat alternatives, dining
out, breakfast, lunch, & snacks, holiday eating, vegetables: benefits/
preparation
Exercise:
benefits of PA, sweating out your do, proper exercise attire, building PA
into your day at work/ home, goal setting, exercise angels, self-reward,
stretching & flexibility benefits, other aerobic exercise, hot/ cold weather
exercise, minor injuries, fitness walking, heart rate, cues and prompts,
exercise interruptions, long-term maintenance of exercise
(Bopp et. al 2009; Yanek et al. 2001)

Measurement Tools
Medical Materials: calibrated digital scale, bioelectrical
impedance tool, tape measure, sphygmomanometer,
UConn laboratory, pedometers
Health History: demographic form, medical history packet
Questionnaires: the Physical Activity Readiness
Questionnaire, the Block Food Questionnaire, the SelfEfficacy for Exercise Questionnaire, the Behavioral RIsk
Factor Surveillance Survey Questionnaire (general health
status and access questions), the Yale Physical Activity
Survey, the Center for Epidemiological StudiesDepression, the Social Support for Diet and Exercise
Questionnaires, the Physical Activity Enjoyment Scale
Bopp et. al 2009; Resnicow et al. 2002; Yanek et al. 2001)

Program Budget

Total Projected Costs for 2.25 years:


$750,000

Marketing Strategies
(Parishioners)

Church Website
Church Bulletin (pastor plugs, weekly health newsletter)
Weekly Angel phone calls
Family video camera footage shared on church projector
Nourishing the Soul cookbook
CD & Poster dissemination
Partnerships with local bodegas, health food stores, supermarkets, and
restaurants
Social Media- Facebook, Twitter, Instagram

Resnicow et al. 2002; Yanek et al. 2001)

Marketing Strategies
(Stakeholders)

health is a community concern


goal: increase longevity of community, uplift the community, empower
the community
church is a community stronghold, place of safety and sanctity, a
holistic site of healing
by reducing rates & risk of CVD, community members can live to rear
the next generation
women are generally at the center of a family, especially in racial/
ethnic minority communities, and can influence others in the household
program will be cost-effective and sustainable, decreasing hospital
expenditures, and decreasing racial/ ethnic health disparities

Potential Funding Sources


NIH: Behavioral and Social Science Research on Understanding and
Reducing Health Disparities ( R01/R21)
NIH: Self-Management for Health in Chronic Conditions (R15)
Catalog of Federal Domestic Assistance: Minority Health and Health
Disparities Research Project Grants #93.307
Rural Assistance Center for ORHP Cooperative Agreement
Local YMCAs
The National Academy of Sports Medicine

References
Bopp, M., Wilcox, S., Laken, M., Hooker, S. P., Parra-Medina, D., Saunders, R., ... & McClorin, L. (2009). 8 Steps to Fitness: a faithbased, behavior change physical activity intervention for African Americans. Journal of physical activity & health, 6(5), 568.
Dodani, S., & Fields, J. Z. (2010). Implementation of the Fit Body and Soul, a Church-Based Life Style Program for Diabetes
Prevention in High-Risk African Americans A Feasibility Study. The Diabetes Educator, 36(3), 465-472.
McKenzie, J. F., Neiger, B. L., & Thackera, R. (2009). Planning, Implementing, And Evaluating Health Promotion Programs: A
Primer Author: James F. McKenzie, Brad L.
Resnicow, K., Jackson, A., Braithwaite, R., DiIorio, C., Blisset, D., Rahotep, S., & Periasamy, S. (2002). Healthy Body/Healthy
Spirit: a church-based nutrition and physical activity intervention. Health Education Research, 17(5), 562-573.
http://en.wikipedia.org/wiki/File:The_Health_Belief_Model.pdf
Yanek, L. R., Becker, D. M., Moy, T. F., Gittelsohn, J., & Koffman, D. M. (2001). Project Joy: faith based cardiovascular health
promotion for African American women. Public health reports, 116(Suppl 1), 68.
https://www.goredforwomen.org/home/live-healthy/
http://www.mindtools.com/pages/article/newHTE_87.htm
http://www.utwente.nl/cw/theorieenoverzicht/theory%20clusters/health%20communication/health_belief_model/
Woods G, Levinson AH, Jones G, Kennedy RL, Johnson LC, Tran ZV, Gonzalez T, Marcus AC. The Living Well by Faith Health and
wellness program for African Americans: an exemplar of community-based participatory research. Ethn Dis. 2013
Spring;23(2):223-9

Questions?