HOPE WorksHOPE Works

2004-20092004-2009Health, Opportunities, Health, Opportunities,

Partnerships and Partnerships and EmpowermentEmpowerment

UNC Center for Health Promotion UNC Center for Health Promotion and Disease Preventionand Disease Prevention

Alice Ammerman, DrPH, RD, DirectorAlice Ammerman, DrPH, RD, Director Marci K. Campbell, PhD, MPH, RD (PI)Marci K. Campbell, PhD, MPH, RD (PI) Salli Benedict, MPH, Project DirectorSalli Benedict, MPH, Project Director Katie BarnesKatie Barnes Peggy Bentley, PhDPeggy Bentley, PhD Brenda DeVellis, PhDBrenda DeVellis, PhD Andrea Meier, PhDAndrea Meier, PhD Kristine Kelsey, PhDKristine Kelsey, PhD Chantelle Fisher-Borne, MPHChantelle Fisher-Borne, MPH Beth Hooten, PhDBeth Hooten, PhD

The evolution of the The evolution of the Health Works projects Health Works projects

from participation to empowermentfrom participation to empowerment

Health Works for Women Health Works for Women (HWW) 1993-1998(HWW) 1993-1998Work-site health promotion project focusing Work-site health promotion project focusing

on individual risk factors (diet and on individual risk factors (diet and exercise) and strengthening social support exercise) and strengthening social support networksnetworks• Worksites included nine textile, apparel, and Worksites included nine textile, apparel, and

light manufacturing companies in Eastern North light manufacturing companies in Eastern North CarolinaCarolina

• Project employed traditional research methods, Project employed traditional research methods, as well as formative research methods as well as formative research methods

The evolution of Health Works: From The evolution of Health Works: From participation to empowermentparticipation to empowerment

Health Works for Women/Health Works in the Health Works for Women/Health Works in the Community Community (HWW/HWC) 1998-2003(HWW/HWC) 1998-2003

• Scope of the project expanded to address Scope of the project expanded to address organizational and community factors that organizational and community factors that impact health and well-being impact health and well-being

• Community Advisory Committee (CAC), Community Advisory Committee (CAC), consisting of workplace representatives, local consisting of workplace representatives, local agencies, advocacy groups, established to agencies, advocacy groups, established to provide guidance and feedbackprovide guidance and feedback

• Plant closings and lay-offs occurred in the Plant closings and lay-offs occurred in the course of project implementationcourse of project implementation

The evolution of the Health Works The evolution of the Health Works projects: projects:

From participation to empowermentFrom participation to empowerment Health Works After the Flood (HWATF) 2000-2003Health Works After the Flood (HWATF) 2000-2003

• In the wake of devastation wrought by Hurricane In the wake of devastation wrought by Hurricane Floyd in 1999, CAC members and UNC initiated Floyd in 1999, CAC members and UNC initiated a project with CDC support to address stress a project with CDC support to address stress and IPV in the months following the floodingand IPV in the months following the flooding

• Composition of the CAC changes to include Composition of the CAC changes to include more community members, domestic violence more community members, domestic violence and mental health agencies, more leadership and mental health agencies, more leadership rather than advicerather than advice

Community Advisory CommitteeCommunity Advisory CommitteeOctober 2006October 2006

Priscilla AllenPriscilla Allen Katie Barnes, ChairKatie Barnes, Chair Sharon BrownSharon Brown Tabatha BrewerTabatha Brewer Consuela CombsConsuela Combs Darlene Leysath DixonDarlene Leysath Dixon Anne DoolenAnne Doolen Pamela GonzalezPamela Gonzalez Addie HallAddie Hall

Barbara HarrisBarbara Harris Katherine Hernandez Katherine Hernandez Judy Johnson-TruittJudy Johnson-Truitt Donna KellyDonna Kelly Mary Bea KolbeMary Bea Kolbe Elizabeth MaynorElizabeth Maynor Pastor Patricia Pastor Patricia

Peterson (Co-chair)Peterson (Co-chair) Imani RiveraImani Rivera Delphine SmithDelphine Smith

Women’s Empowerment Days Women’s Empowerment Days Community Advisory Committee Project Community Advisory Committee Project

20032003In response to community concerns In response to community concerns

about the economic downturn and about the economic downturn and the need for grassroots development the need for grassroots development and empowerment effortsand empowerment efforts

Planned and implemented by the Planned and implemented by the Community Advisory CommitteeCommunity Advisory Committee

Address health Address health andand economic needs of economic needs of blue collar womenblue collar women

Community-wide eventsCommunity-wide events New linkages among agenciesNew linkages among agencies

Community Partner: MBA Community Partner: MBA (Multicultural Business Association)(Multicultural Business Association)

““Poverty is hazardous to women’s Poverty is hazardous to women’s health”: health”:

The link between health and povertyThe link between health and poverty Considerable micro-level research suggests a strong Considerable micro-level research suggests a strong

relationship between individual health and income (i.e. relationship between individual health and income (i.e. poverty leads to lower health status)poverty leads to lower health status)

Important findings include:Important findings include:• Income level is a more important predictor of health status Income level is a more important predictor of health status

than income changethan income change• Income level has a greater impact on the health status of poor Income level has a greater impact on the health status of poor

than high-income individualsthan high-income individuals• Extended periods of time in poverty have a greater and more Extended periods of time in poverty have a greater and more

negative impact on health than occasional episodes of povertynegative impact on health than occasional episodes of poverty

Phipps, S. Phipps, S.

Loss of traditional industries in eastern Loss of traditional industries in eastern NCNC

The manufacturing industry in the United States The manufacturing industry in the United States has experienced extensive economic has experienced extensive economic restructuring in the past 30 years, primarily restructuring in the past 30 years, primarily affecting rural areas in the Southeast. affecting rural areas in the Southeast.

Between 1997 and 2002, North Carolina lost Between 1997 and 2002, North Carolina lost 100,000 jobs in the textile industry and 70,000 100,000 jobs in the textile industry and 70,000 jobs in the apparel industry.jobs in the apparel industry.

Hossfeld L, Legerton M, Keuster G. Hossfeld L, Legerton M, Keuster G. Kalishman J, Stogner S, Ramey J. Kalishman J, Stogner S, Ramey J.

HOPE WorksHOPE Works Builds on HWW-1 and HWW-2/HWCBuilds on HWW-1 and HWW-2/HWC Community-based participatory research Community-based participatory research

project, active participation of Community project, active participation of Community Advisory CommitteeAdvisory Committee

Addresses high prevalence of obesity…Addresses high prevalence of obesity… ……andand addresses social determinants of addresses social determinants of

health (education, employment, living health (education, employment, living situations)situations)

Modeled on loan circles/microenterpriseModeled on loan circles/microenterprise

Health Determinants

Community factors•Employment•Housing•Economic systems•Education•Culture and history

Environment factors•Built environment•Rurality•Flood damage and recovery

Individual factors•Socioeconomic•Language•Culture•Education•Family•Health status

Intermediate Outcomes

Health and Social ChangeOutcomes

Community level•Neighborhood resources•Opportunities for learning and developing capacity•Community development and employment opportunity•Community involvement,collective efficacy, social capital•Health and obesity prevention resources•Partnerships/linkages

Individual level•Goal achievement•Self-efficacy•Knowledge/awareness•Skills and capacity building•Social support•Health behavior changes

Obesity preventionHealth promotionEmpowermentHOPE

HOPE Works Conceptual Model

HOPE WorksIntervention

HOPE WorksHOPE Works Intervention expands to larger Intervention expands to larger

community, not just workplacescommunity, not just workplaces Retain women’s health focusRetain women’s health focus Address link between health, Address link between health,

poverty, and hopepoverty, and hope Goal setting Goal setting Uses third world community Uses third world community

development principles and modelsdevelopment principles and models

Planning for HOPE Works Planning for HOPE Works (2003-2004)(2003-2004)

CAC women trained to lead focus CAC women trained to lead focus groups (8 focus groups conducted)groups (8 focus groups conducted)

CBPR Process/Committees formed:CBPR Process/Committees formed:• Facilitator trainingFacilitator training• MarketingMarketing• KickoffKickoff• Evaluation (baseline and community surveys)Evaluation (baseline and community surveys)

HOPE Works InterventionHOPE Works Intervention HOPE CirclesHOPE Circles

Low income, overweight women, multi-Low income, overweight women, multi-ethnic (African American, white, Latina, ethnic (African American, white, Latina, Coharie Tribe)Coharie Tribe)

Circles led by trained leaders from the Circles led by trained leaders from the communitycommunity

Experiential learning (fitness activities, ice Experiential learning (fitness activities, ice breakers, healthy food)breakers, healthy food)

Provide social support, information, Provide social support, information, strategies for health behavior changestrategies for health behavior change

Goal-setting in health and hope domains Goal-setting in health and hope domains (e.g. getting education, jobs, housing, etc)(e.g. getting education, jobs, housing, etc)

Circle Leader TrainingCircle Leader Training Friday evening, all day SaturdayFriday evening, all day Saturday Experiential: ice breakers, fitness Experiential: ice breakers, fitness

activities (music), healthy foodactivities (music), healthy food Presentations on weight Presentations on weight

management, healthy eating, fitness, management, healthy eating, fitness, stress, economic empowermentstress, economic empowerment

Goal setting: didactic and practiceGoal setting: didactic and practice Monthly meetingsMonthly meetings

HOPE Works InterventionHOPE Works Intervention

Tailored newsletters (6) that address Tailored newsletters (6) that address both health and hope-related issues both health and hope-related issues and goalsand goals

Community-wide events and Community-wide events and interventions; new focus on interventions; new focus on advocacyadvocacy

EvaluationEvaluation

--250 women in HOPE circles vs. 250 --250 women in HOPE circles vs. 250 comparison womencomparison women• Individual change in weight, diet, PA, hope, Individual change in weight, diet, PA, hope,

self-efficacy, social support, community self-efficacy, social support, community involvement, social capital, psychological involvement, social capital, psychological and economic well-beingand economic well-being

--Comparison of HOPE Works counties with --Comparison of HOPE Works counties with neighboring counties via random neighboring counties via random surveys (via mail)surveys (via mail)• Health behaviors, awareness, community Health behaviors, awareness, community

involvement, social capital, hopeinvolvement, social capital, hope

Qualitative Evaluation of Qualitative Evaluation of Circle LeadersCircle Leaders

Personal life and health-related Personal life and health-related changes in Leaderschanges in Leaders

Interviews, photo voiceInterviews, photo voice Formative: intervention adaptations Formative: intervention adaptations

Preliminary data: random Preliminary data: random community surveys*community surveys*

What do you believe is the single What do you believe is the single biggest issue facing your community biggest issue facing your community today?today?

Jobs and the economyJobs and the economy Drugs/alcoholDrugs/alcohol Social change/social capitalSocial change/social capital Poverty Poverty Hispanic immigrationHispanic immigration Cost of health care, prescriptionsCost of health care, prescriptions Environment (hog, poultry farms, landfill)Environment (hog, poultry farms, landfill) *511 surveys: over 80% completed this question*511 surveys: over 80% completed this question

““No jobs. Most of the factories are closingNo jobs. Most of the factories are closing—send the work overseas. If they keep —send the work overseas. If they keep this up no one will be able to buy their this up no one will be able to buy their products when it comes back to America products when it comes back to America because no one will have jobs. The gas because no one will have jobs. The gas prices have increased faster than the cost prices have increased faster than the cost of living increases in wages. Depression is of living increases in wages. Depression is hitting everyone because they cannot hitting everyone because they cannot afford what they’ve been having. No jobs, afford what they’ve been having. No jobs, no pay increase, but everything keeps no pay increase, but everything keeps going up. Yes everything was better years going up. Yes everything was better years ago. So obesity and health problems are ago. So obesity and health problems are on the rise. This problem will continue to on the rise. This problem will continue to increase as long as there is no jobs and increase as long as there is no jobs and depression from losing everything grows.”depression from losing everything grows.”

““In my community we don’t have anywhere In my community we don’t have anywhere for the children to go like a recreation for the children to go like a recreation center and its hardly any stores or center and its hardly any stores or restaurants where I live it’s a very small restaurants where I live it’s a very small town. Something about me I am 31 years town. Something about me I am 31 years old, single mother with asthma. I have 3 old, single mother with asthma. I have 3 children ages 10, 7 and 5. I would really children ages 10, 7 and 5. I would really like to lose weight for my health and to do like to lose weight for my health and to do more things with my children. I weigh more things with my children. I weigh about 300 pounds right now. And its hard about 300 pounds right now. And its hard for me to try and exercise because of my for me to try and exercise because of my asthma and then my breasts are real big.”asthma and then my breasts are real big.”

Preliminary analysis of random Preliminary analysis of random community surveys : Hopecommunity surveys : Hope

Hope is significantly higher among Hope is significantly higher among women with more education and women with more education and income, higher self-reported health, income, higher self-reported health, more healthy days/month (BRFSS), more healthy days/month (BRFSS), more positive perceptions of their more positive perceptions of their community’s economic and social community’s economic and social capital.capital.

Hope higher among employed Hope higher among employed womenwomen

Preliminary random survey Preliminary random survey analysis: Hopeanalysis: Hope

Level of hope was not different by Level of hope was not different by age or raceage or race

Level of hope and body mass index: Level of hope and body mass index: there was significantly lower hope there was significantly lower hope among more obese (controlling for among more obese (controlling for age, race, and education)age, race, and education)

HOPE Works…?HOPE Works…?

Will the HOPE Works intervention that Will the HOPE Works intervention that links health promotion/obesity links health promotion/obesity prevention with social support and prevention with social support and economic education/empowerment economic education/empowerment result in positive health and hope result in positive health and hope outcomes for women?outcomes for women?

Seeds of HOPESeeds of HOPE Goal: to create a sustainable model Goal: to create a sustainable model Born of growing interest in the importance Born of growing interest in the importance

of economic empowerment to women’s of economic empowerment to women’s health and community developmenthealth and community development

Opportunities, training, education, Opportunities, training, education, resources for enhancing economic resources for enhancing economic empowerment and community wealth empowerment and community wealth

Community-led partnership w/UNC, CDC, Community-led partnership w/UNC, CDC, business and entrepreneurial organizations: business and entrepreneurial organizations: one-year participatory strategic planning one-year participatory strategic planning processprocess

Seeds of HOPE PartnersSeeds of HOPE Partners UNC (Jim Johnson, Anita Brown UNC (Jim Johnson, Anita Brown

Graham, Jesse White)Graham, Jesse White) Community (community colleges, Community (community colleges,

economic development agencies)economic development agencies) Good WorkGood Work NC Rural CenterNC Rural Center NCSU College of Design and Textile NCSU College of Design and Textile

SchoolSchool

Seeds of HOPE Seeds of HOPE Strategic Plan GoalsStrategic Plan Goals

Start a business that will serve as an Start a business that will serve as an example of an exemplary worker-example of an exemplary worker-owned businessowned business

Increase financial education across Increase financial education across all HOPE Works activitiesall HOPE Works activities

Increase networking with Increase networking with organizations that support organizations that support entrepreneurial activitiesentrepreneurial activities

Threads of HOPE: Threads of HOPE: Creation of a Creation of a

Woman-owned BusinessWoman-owned Business

The Seeds of HOPE strategic plan: to The Seeds of HOPE strategic plan: to create Threads of HOPEcreate Threads of HOPE

Build on skills of unemployed Build on skills of unemployed textile/apparel workerstextile/apparel workers

Unique design or product to reflect Unique design or product to reflect HOPE Works values, place and cultureHOPE Works values, place and culture

Collaboration with NCSU College of Collaboration with NCSU College of Design (and Penelope Bags?)Design (and Penelope Bags?)

Threads of HOPE GoalsThreads of HOPE Goals Training for low income women in every Training for low income women in every

aspect of running a businessaspect of running a business Worker ownedWorker owned Living wageLiving wage Health benefitsHealth benefits Health promoting business/HOPE CirclesHealth promoting business/HOPE Circles Leadership developmentLeadership development Opportunity to pursue educational goalsOpportunity to pursue educational goals

Threads of HOPE ActivitiesThreads of HOPE Activities Collaboration with NCSU School of Collaboration with NCSU School of

Textile and College of DesignTextile and College of Design Student contest: unique Threads of Student contest: unique Threads of

HOPE designHOPE design Meetings with community womenMeetings with community women Ms. Tuggle’s DraperiesMs. Tuggle’s Draperies Contract with PRC Annual meetingContract with PRC Annual meeting