YEAR 1 EVALUATION REPORT 

Norton Healthcare Centers for Prevention and 

Wellness 

August 2013 
YEAR 1 EVALUATION REPORT 

Norton Healthcare Centers for Prevention and Wellness 

August 2013 

Acknowledgements 

This report was developed under grant #10SIHKY001 
2 

Get Healthy Access Program

Year 1 Evaluation Report

Contents 

Executive Summary.................................................................................................................... 3 

Background............................................................................................................................... 4 

Methods................................................................................................................................... 6 

Preliminary Findings ..................................................................................................................10

Discussion ...............................................................................................................................22

Appendix A ..............................................................................................................................23

Appendix B ..............................................................................................................................25

 
3 

Executive Summary 

The Get Healthy Access Program (GHAP), administered by the Norton Healthcare Centers for Prevention 

and Wellness, received funding from the Kentucky Healthy Futures Initiative in 2011. The program offers 

cardiovascular screenings and education and navigation for at-risk individuals needing follow-up care, 

with the long-term goal of improving health outcomes for participants. 

During the first year of the GHAP program (April 2012 to April 2013), data was collected to evaluate the 

implementation and initial program impact. Data was collected on individuals enrolled at screenings 

(N=211) and included demographic characteristics, health behaviors, blood pressure, and body mass 

index. Some of these screened individuals were ineligible or dropped out after initial screening. At the 

end of year one, 134 people were active participants in GHAP. Follow-up data was collected from these 

enrollees with three (N= 50) and six month (N = 14) surveys and also from primary care providers the 

participants visited. Also, qualitative data was collected from program staff during a focus group. 

Preliminary Findings from year one of the Get Healthy Access Program are below: 

Implementation: 

 4,516 people were screened in 178 screening events in the Louisville metro area. 750 people 

were found to be eligible. 

 The number of initial enrollees is 211 (28% of those found to be eligible) and the number of 

active enrollees at the end of the first year of GHAP is 134 (18% of those found to be eligible). 

 89 of the individuals 211 enrolled initially were later excluded for failure to meet clinical 

enrollment criteria 

 It was estimated that 300 people would be enrolled in GHAP at the end of year one. There were 

134 actual enrollees at the end of year one. Reactions from staff collected during a focus group 

regarding differences between program expectations and observations are summarized below. 

o Enrollment was lower than expected for the first year due to the following reasons: 

 Comorbidity among potential enrollees was higher than expected. 

 Group interventions did not attract the number of participants expected. 

 Facebook was not as popular as expected. 

 33% (44/134) of enrolled participants had completed the program’s group or individual 

intervention at the end of year one. 

 At baseline, 14% (19/134) of active enrollees were participating in community resources, such as 

YMCA or Norton Healthcare programs at the end of one year, 50% (25/50) of those surveyed 

three months following their screening were participating in community resources. 

 42% (21/50) of surveyed participants (three month survey) used the social media component of 

the program. 

 Components of program success, according to staff: 

o Optimistic and flexible staff that were able to make changes and solve problems quickly. 

o Connections made between enrollees and GHAP staff through interventions, phone 

calls, and text messages kept participants engaged. 
4 

o Recognition that screening events carried out in conjunction with another event were 

more successful than stand-alone screening events. 

o Participants appreciate the service and have a need for it. 

 Components of barriers to program participation, according to staff: 

o Some of the population may have contextual and environmental issues, such as 

substance abuse and mental illness that prevent enrollment. 

o Participants not eligible due to having other illnesses or already having a PCP. 

o Some enrollees unable to participate in group interventions due to limited time or no 

childcare. 

o Program elements seen as barriers include waiting for IRB approval and getting 

information to and from PCPs. 

Impact: 

 During the first year of GHAP, 98% of active program participants (131/134) were navigated to 

and met with a PCP at least one time 

o 46% (50/109) of those eligible to have a second PCP visit, met with a PCP twice. 

 Of those who stated they smoked at baseline who were surveyed at three month follow-up, 

53% (8/15) said they made at least one quit attempt. 

 Of those who answered the physical activity question at baseline and three month follow-up, 

51% (19/37) had increases in weekly physical activity frequency. 

 Of those who answered the fruit and vegetable consumption question at baseline and three 

month follow-up, 37% (16/43) had increases in weekly fruit and vegetable consumption. 

 Data shows that 55% (21/38) of enrollees with higher than normal blood pressure who had a 

second PCP visit had categorical decreases in which blood pressure moved from a higher 

category to a lower one. 

 25% (5/20) of enrollees with diabetes or prediabetes at the 1st PCP visit who also had a 2nd PCP 

visit, had a decrease in which HbA1c levels moved from diabetes to prediabetes or no diabetes 

(Hba1c level of 5.6% or less is normal; Hba1c level of 5.7% to 6.4% is prediabetes; Hba1c level of 

6.5% or higher is diabetes) . 

 10% (4/40) of enrollees with higher than normal BMI at the 1st PCP visit who also had a 2nd PCP 

visit, had a categorical BMI decrease. 

Background 

The Get Healthy Access Program (GHAP) is administered by the Norton Healthcare Centers for 

Prevention and Wellness (CPW). The program offers cardiovascular screenings and education and 

navigates individuals with risk factors for cardiovascular disease and metabolic syndrome to follow-up 

care and evidence-based interventions to promote physical activity and dietary lifestyle changes. The 

overall goal of GHAP isto improve health outcomes for individuals participating in the program. 
5 

In November 2011, CPW received funding from the Kentucky Healthy Futures Initiative (KHFI) to start 

GHAP. This funding helped to expand the current Cancer Prevention and Early detection community 

screening and navigation program to cardiovascular screening and navigation. The target population for 

GHAP is low-income, uninsured individuals in the Louisville Metro area. 

The GHAP program offers community cardiovascular screenings to identify patients with risk factors for 

cardiovascular disease and metabolic syndrome. During the screening, program staff assess blood 

pressure, body mass index, and medical history. When indicated, individuals receive assessment of 

blood glucose and cholesterol. Along with screenings, program staff provide education and information 

to expand awareness of cardiovascular disease and stroke risk. Staff discuss initial findings with 

patients and individuals who are eligible for GHAP are asked to participate. Individuals eligible for GHAP 

are those age 18-64, having no primary care provider (PCP), having not been to a PCP for one year or 

more, and exhibiting obesity, pre-hypertension, pre-diabetes, and/or hyperlipidemia. Initially, having no 

health insurance was also an eligibility requirement, but this was changed during the first year. Those 

who consent to be in the program take part in many program elements, including interventions (group 

or individual) that educate on nutrition and physical activity; assistance finding a primary care provider 

and scheduling appointments; assistance accessing community resources, such as YMCA; and 

motivational messages by phone, text or email. The GHAP staff also contact the participant at three, six, 

and 12 months after the initial screening to conduct follow-up surveys (see Figure 1). At the end of the 

12 month period, participants will receive a letter and certificate of completion. 

Figure 1: Process of GHAP Program 

Patients screened in 

community

Pre-assessment 

(assessment of blood 

pressure, BMI, blood sugar,

cholesterol, medical 

history; data collected)

Eligible and consenting 

patients are enrolled

GHAP Nurse Navigator 

contacts participants

Navigates participants to 

PCP

Individual or group 

counseling offered

Community resources 

offered

Motivational messages 

sent (text, email, phone, 

letter)

Post-screening 

assessments given at 3, 6, 

and 12 months
6 

At the time funding began, CPW began working with an outside evaluator to develop the subgrantee 

evaluation plan (SEP). The SEP was approved by the Corporation for National and Community Service 

(CNCS), the federal funding agency, in April, 2012, and the program began screening individuals at this 

time. The SEP outlines steps to conduct an implementation and impact evaluation of GHAP, which 

includes identification of indicators, data sources, and time frames for collection of data that will answer 

the implementation and impact evaluation questions below. 

Implementation 

1. Was GHAP implemented as planned regarding screenings, participant enrollment, and 

participant retention? 

a. Did the enrolled group engage in the program interventions as planned? 

2. How much variation in implementation fidelity occurred? 

a. On what aspects of implementation was the greatest variation? 

3. What factors contributed to successful program participation or completion? 

4. What barriers prevented successful program participation or ability to complete the program? 

Impact 

1. To what extent has the health care navigation model been successful? 

a. To what extent did enrolled individuals make contact with primary care medical 

providers? 

b. To what extent did enrolled individuals make suggested lifestyle changes (e.g. diet, 

exercise, avoidance of tobacco) after beginning this program? 

c. To what extent did health outcomes targeted by this project improve for participants? 

2. Were enrolled individuals who use social media more likely to change behaviors than 

participants’ not using social media? 

3. Was there a difference in health outcomes based on the type of practice (community clinic, 

private non-profit, other)? 

Methods 

Evaluation for GHAP during the first year included quantitative and qualitative methods. Quantitative 

data were collected during screenings with the intake form and at follow-up with the three and six 

month surveys were administered by telephone and in-person when participants were able to meet 

with GHAP program staff for interventions. The completed intake data collection forms and surveys 

were reviewed by program staff to detect errors and missing information prior to entry into an Access 

database by program staff. Then the data was checked for completeness by the program analyst. 

Medical chart data collected from program PCP visits was also entered into the database. This database 

was de-identified and provided to the evaluators after IRB approval was obtained. 
7 

To collect qualitative data describing the program and its performance, we conducted a focus group of 

nine program staff in Louisville on June 3, 2013. The focus group was facilitated by Mark Dignan and 

recorded by Kate Jones. The purpose of the focus group was to gain information on the successes and 

barriers of the first year of implementation of GHAP. The roles of the focus group participants include 

program assistant, nurse and lay health navigator, nurse practitioner, outreach coordinator, grants 

coordinator, strategic planning and evaluation, and principal investigator. Three participants were with 

the program since planning stages, three were with the program since it began (about one year and two 

months) and three started within one year or less. A summary of the findings from the focus group are 

available in Appendix B. 

Detailed methods of data collection for the first year of GHAP are described below for both program 

implementation and impact. 

Implementation Evaluation Methods 

The evaluation of the GHAP’simplementation included the collection and analysis of program data from 

a variety of sources, listed in Table 1, which also includes the specific indicators used for the evaluation. 

 

Table 1: Indicators and Data Sources: Implementation 

Data Source Data Collection 

Method

Implementation Indicators

Program Tracking Document review  Number of screenings

 Number of individuals enrolled

 Number of enrollees completing follow-up 

survey

 Number of Active Participants (Participants 

retained)

 Number of enrollees participating in group 

interventions

 Number of enrollees participating in 1-on-1 

interventions

Enrollees Baseline intake forms 

and follow-up 

participant surveys

 Number of enrollees accessing community 

resources

 Number of enrollees participating in social 

media intervention

Staff Focus Group  Fidelity of Implementation, actual to plan

 Implementation success factors

 Implementation challenges
8 

For the first year of GHAP, the evaluation of the program’s implementation included collecting 

information on the number of screenings that occurred, the number of individuals enrolled, and the 

number retained in the program. This information was collected from program tracking and the 

quarterly reports to KHFI. Implementation evaluation also included tracking the number of enrollees 

participating in group and one-on-one interventions, which was collected from the program tracking. 

The number taking part in community resources for diet, exercise and tobacco cessation, as well as the 

number using social media components of the program, were also tracked for implementation 

evaluation. This information was taken from the baseline intake form and the follow-up surveys. The 

number of participants who completed the follow-up surveys is also part of the evaluating the 

implementation of the program and this information was gathered from the KHFI quarterly reports, as 

well as program records. Also, the number of participants for which the program received information 

from the PCP (for those who visited a PCP after screening) was collected from PCP follow-up data. 

Information on where staff felt there was variation in the intervention of GHAP versus what was 

planned was gathered from the staff focus group conducted after the first year of implementation. 

Information on major differences in GHAP’s implementation versus the program’s work plan was also 

collected from the focus group. This includes how the number of enrolled, the number of enrolled 

participating in interventions, and number of enrolled participating in social media differed from what 

the program planned and expected. 

Information on environmental and program attributes that staff felt helped participants succeed in the 

program was collected during the staff focus group. Information on environmental and program 

elements that participants felt helped them to participate successfully in the program is also being 

collected with the 12-month follow-up survey and is not available yet. 

Information on environmental and program attributes that staff perceived as barriers to 

successful program participation was collected during the staff focus group. Information on 

environmental and program elements that participants perceived as barriers to successful program 

participation is being collected with the 12-month follow-up survey and is not available yet. 

Impact Evaluation Methods 

The evaluation of the GHAP’s impact included the collection and analysis of enrollee data, listed in Table 

2, which also includes the specific indicators used for the evaluation. 

 

Table 2: Indicators and Data Sources: Impact

Data Source Data Collection 

Method

Implementation Indicators

Primary Care 

Providers

Document review  Number of enrollees with first and second PCP 

visits

 Blood pressure, blood sugar, Body Mass Index 

(BMI) or Waist Circumference
9 

Enrollees Baseline intake forms 

and follow-up 

participant surveys

 Number of enrollees who met with a PCP during 

each follow-up period

 Number of enrollees who felt that meeting with 

a PCP helped somewhat or a lot to change 

behaviors

 Smoking, physical activity, fruit and vegetable 

consumption by enrollees

 Number of enrollees who used the social media 

component of the program (motivational 

messages by text or email)

 Number of enrollees who felt the social media 

component (motivational messages by text or 

email) helped them change behaviors

 Blood pressure, blood sugar, BMI or Waist 

Circumference

Data on the number of program participants who met with a PCP at least once was gathered from the 

program tracking. GHAP enrollees visited two different PCPs—Shawnee Christian Healthcare Center 

(Shawnee) and Charasika Open Access Healthcare (Open Access). Also, the number of participants who 

met with a PCP during each follow-up period of those who were surveyed at three and six months was 

collected from the follow-up surveys. Information on the number of participants surveyed who said that 

meeting with a PCP helped somewhat or helped a lot to change behaviors was collected from the three 

and six month follow-up survey. 

The number of participants surveyed who reported decreasing smoking or making quit attempts, 

increasing physical activity, or increasing fruit and vegetable consumption was collected with the three 

and six month follow-up survey data. 

Data was also collected on participants’ blood pressure, blood sugar, and Body Mass Index (BMI) or 

Waist Circumference (WC) at baseline screening and with the six month follow-up survey, which was in 

person, and during the PCP visits. To establish a consistent measurement the true baseline for these 

measurements was set to be the PCP measurements, where baseline is the first visit and follow-up 

measurements are from the second visit. This outcome data was also examined by each provider. 

Data on the number of participants who used the social media component of the project and the 

number who report that social media helped them change behaviors was collected from the three and 

six month follow-up survey. 

Differences in health behaviors measured at screening (smoking, physical activity, fruit and vegetable 

consumption) and health outcome variables measured at screening (blood pressure, blood sugar, and 

BMI) were reviewed and tested using statistical tests. These behavior and outcome data were examined 
10

to identify differences in demographics, such as gender, race and age. Categorical demographic variable 

differences (gender and race) were analyzed using Chi-square tests. For continuous variables, t-tests 

and ANOVA were used for analyses. 

Preliminary Findings 

Implementation 

Was GHAP implemented as planned regarding screenings, participant enrollment, and participant 

retention? 

We assessed the expected and actual reach of the screening effort to determine the fidelity of program 

implementation to the plan. During the first year of GHAP (from April, 2012 to April, 2013), 4,516 people 

were screened in 178 screening events in the Louisville metro area. This is an increase of 3,016 from the 

1,500 screenings that were planned prior to the program implementation. Numbers of screenings are as 

follows; 2,582 BMI, 3,655 blood pressure, 928 blood sugar, and 256 cholesterol screenings occurred. 

Each of these screenings exceed expectations set during program planning; 1,082 more BMI; 2,155 more 

blood pressure; 678 more blood sugar; and 6 more cholesterol screenings took place than was planned 

(Figure 2). 

Figure 2: GHAP Screening Numbers: Planned, Actual and Difference 

3016

1082

2155

678 6

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

Any Screen BMI Tests Blood pressure Blood Glucose Cholesterol

GHAP Screenings

Predicted

Actual

Variance

From these screenings, 750 people were found to be eligible and invited to participate in the 

intervention. The number of individuals who completed enrollment in the program during the first year 
11

is 211. This is 89 (30%) less than program expectations of 300. The quarterly report submitted to KHFI in 

April, 2013 presented the number of active enrollees in the program at the end of the first year to be 

138. However, this number includes participants who attended a PCP and later withdrew from the 

program or were found to be medically ineligible. The actual number of active enrollees at the end of 

the first year of GHAP is 134 or 45% of the expected enrollment. 

Did the enrolled group engage in the program interventions as planned? 

Participation in the program elements were included as indicators of participant engagement 

with the GHAP. During the first year of GHAP, 44% of participants eligible for follow-up

(50/114) completed the 3-month follow-up survey. Of these 114 participants, 83 were eligible 

for 6-month follow up during the reporting period. 17% (14/83) of them completed the 6-month 

follow-up survey. Also during the first year, program staff obtained PCP follow-up information 

from 98% of active participants (131/134). 

Data from the first year of GHAP implementation show that 33% (44/134) of participants 

completed the program’s group or individual intervention. At the three month follow-up survey, 

50% (25/50) were participating in community resources (11 YMCA/exercise program, 13 

walking, 1 diet). This is an improvement from baseline (screening), where only 14% of all active 

participants (19/134) reported using community resources to help change behaviors. 

The percentage of surveyed participants who reported using the social media component of the 

program was 42% (21/50) at the three month follow-up survey. This percentage was 50% (7/14) 

at the 6 month follow-up survey. 

How much variation in implementation fidelity was there? 

On what aspects of implementation was the greatest variation? 

According to GHAP staff, there was variation from what was planned in multiple areas of the program 

during the first year of GHAP’s implementation. First, staff noted that turnout for screening events 

varied across sites and that events that were in conjunction with another event conducted by the 

organization hosting the screening event, yielded a greater number screened than screenings that were 

not held with another event. Armed with this information, staff also expected more people to be 

enrolled at the end of year one, even though they felt the number of people enrolled at the end of the 

first year was an accomplishment. During program planning, it was expected that 300 people would be 

enrolled at the end of year one and the number of initial enrollees is actually 211 (134 (45%) active). 

Staff indicated that the comorbidity level of the population was higher than expected. Also during 

planning, GHAP staff expected to be able to include many PCPs in the group of PCPs that were used by 

participants. However, this turned out to not be feasible when the electronic health record system was 

implemented. Only two PCPs (community clinics) were used by GHAP participants during the first year. 

Finally, GHAP’s implementation may have been affected from what was expected by the community 

where group interventions were not as popular as expected. Another difference from what was 
12

expected was a low turnout for the GHAP Facebook page, regarding the number of people who “like” 

the page. 

What factors contributed to successful program participation or completion? 

The program attributes that staff felt helped participants succeed in the program were an optimistic 

team that was also flexible to make changes in schedules and quickly find solutions to problems that 

arose. Also, staff said that enrollees are likely to stay engaged in the program because of the 

connections being made between enrollees and GHAP staff each month through interventions, phone 

calls and text messaging. Staff also felt that the program has been successful because there is a wellrecognized need in the population and people appreciate the service. 

What barriers prevented successful program participation or ability to complete the program? 

Elements that staff felt were barriers to successful program participation during year one include people 

being uninterested in enrolling and people being ineligible to enroll. Staff felt that environmental or 

contextual issues that some potential participants may be dealing with in their lives may be causing 

them to not be ready or unable to participate. Some people may be dealing with substance abuse or 

mental illness. Others, who were thought to be eligible at screening, were actually ineligible because he 

or she did have a PCP but were not going as frequently as needed. Other barriers for participation in 

GHAP include limited resources for those who are enrolled. For example, enrollees felt they did not have 

enough money to join a gym when they are given recommendations to increase physical activity. Also, 

barriers for enrollees to participating in group interventions include not having childcare or time to 

devote to attending the group meetings. Staff found that individual interventions given by phone were 

more convenient to enrollees than group interventions.

Program elements that were found to be barriers to GHAP implementation were the IRB process 

delaying the start of GHAP initially. Also, having to fax reports to PCPs was a time-consuming process 

that staff felt hindered GHAP’s implementation. 

Impact 

To what extent has the health care navigation model been successful? 

To what extent did enrolled individuals make contact with primary care medical providers? 

During the first year of GHAP, 98% of active program participants (131/134) were navigated to 

and met with a PCP at least one time. Of those eligible to have a second PCP visit (participants 

had a second PCP visit three months after the initial PCP visit; participants eligible for a second 

PCP visit are those who had an initial PCP visit on January 31, 2013 or earlier), 46% (50/109) met 

with a PCP twice. Of those who met with a PCP at least once, 49% (64/131) went to Charasika 

Open Access Healthcare and 50% (66/131) went to Shawnee Christian Healthcare Center. Of 

those who met with PCP twice, 56% (28/50) went to Charasika Open Access Healthcare and 44% 

(22/50) went to Shawnee Christian Healthcare Center. 

Of active participants who were surveyed for the three month follow-up survey, 66% (33/50) 

responded that they met with a PCP at least once since the screening. Of those surveyed for the 
13

six month follow-up survey, 50% (7/14) said they met with a PCP at least once since the last 

survey. This percentage is lower than program data shows above, which is obtained by 

contacting PCPs directly to determine who has had a visit. This may in part be due to 

participants not considering the PCP they visited their own personal doctor or healthcare 

provider. Respondents indicated that meeting with a PCP influenced a change in healthy 

behaviors: 84% (32/38) said that meeting with a PCP somewhat helped or helped a lot to 

influence this type of change at three months and 77% (10/13) said it helped somewhat or a lot 

at 6 months. 

To what extent did enrolled individuals make suggested lifestyle changes (e.g. diet, exercise, 

avoidance of tobacco) after beginning this program? 

Data from the baseline survey and the follow-up surveys provide results for lifestyle changes 

that were or were not made by participants (See Appendix A for table). Follow-up survey data is 

limited at the end of year one, as not all participants were eligible for follow-up surveys at three 

and six months, and no 12 month surveys were complete. More data will be available for the 

year two report and analyses will include changes from baseline at three, six and 12 months. 

At baseline 36% (48/133; 1 missing) stated they were smoking. Of those surveyed for the three 

month follow-up survey 30% (15/50) responded that they smoked in the last month. Of those 

surveyed at the six month follow-up survey, 14% (2/14) said they smoked in the last month. 

However, none of those who were smoking at baseline had quit at follow-up. Of those who 

stated they smoked at baseline who were surveyed at three month follow-up, 53% (8/15) said 

they made a quit attempt. At six month follow-up, 100% (2/2) who were smoking at baseline 

had made a quit attempt. 

At baseline, 23% (28/124) of participants said they were never physically active. At the three 

month follow-up survey, 18% (9/49) of surveyed participants said they were never physically 

active during the past month. Of those who answered the physical activity question at baseline 

and three month follow-up, 51% (19/37) had increases in weekly physical activity frequency. Of 

those who responded at baseline that they were not physically active who were surveyed at 3 

months (7), five had been physically active in the past month. 

At baseline, 82% (108/131) of active participants said they eat less than five servings of fruits or 

vegetables each day. At the three month follow-up survey, 83% (39/47) of surveyed participants 

said they eat less than five servings of fruits or vegetables each day. Of those who answered the 

fruit and vegetable consumption question at baseline and three month follow-up, 37% (16/43) 

had increases in weekly fruit and vegetable consumption. Of those who responded at baseline 

that they consume less than five servings of fruits or vegetables each day who were surveyed at 

3 months, 17% (7/41) stated they now eat five or more servings of fruits or vegetables per day 

during the past month. 
14

To what extent did health outcomes targeted by this project improve for participants? 

During the first year of GHAP, data was collected that shows improvements in participants’ 

health outcomes (see Appendix A for table). Of participants who had a first PCP visit, 22% 

(29/130) had normal blood pressure, 50% (65/130) were hypertensive/had high blood pressure. 

Data show that 55% (21/38) of enrollees with higher than normal blood pressure who had a 

second PCP visit had categorical decreases in which blood pressure moved from a higher 

category to a lower one (see Figure 3 for categories). 

 Of enrollees found to be in hypertensive crisis (systolic higher than 180 or diastolic higher 

than 110) at the first PCP visit, three enrollees moved to a lower category at the second PCP 

visit (1 to normal and 2 to high blood pressure stage 2). 

 Of enrollees found to have high blood pressure stage two (excluding those in 

hypertensive crisis) at the first PCP visit (systolic from 160 to 180 or diastolic from 100 to 

110), five enrollees had moved to a lower category at the second PCP visit (1 to normal, 

2 to prehypertension, and 2 to high blood pressure stage one). 

 Of enrollees with high blood pressure stage one at the first PCP visit (systolic from 140 

to 159 or diastolic from 90 to 99), seven enrollees had a lower category of blood 

pressure at the second PCP visit (5 prehypertension and 2 normal). Of enrollees with 

prehypertension at the first PCP visit (systolic from 120 to 139 or diastolic from 80 to 

89), six enrollees had normal blood pressure at the second PCP visit. 

 Data from first PCP visits also shows that 8% (9/119) of participants had diabetes (HbA1c levels 

6.5% or above) and 45% (54/119) had pre-diabetes (HbA1c of 5.7 to 6.4%). Of those who had 

second PCP visits, 2% (1/42) had diabetes and 55% 

(23/42) had pre-diabetes. Of enrollees with diabetes 

or pre-diabetes at the first PCP visit who also had a 

second PCP visit, 25% (5/20) had a decrease in 

diabetic category at the second PCP visit. Two 

enrollees who were found to have diabetes at the 

first PCP visit measured in the pre-diabetes category 

at the second PCP visit. Three enrollees with prediabetes at the first PCP visit, were found to have 

normal HbA1c levels at the second visit. 

 Some participants showed decreases in obesity, 

as defined by BMI or waist circumference (WC), from 

the first PCP visit to the second. At the first PCP visit, 

65% (77/119) of enrollees were obese (BMI at or 

above 30) and 28% (33/119) were overweight (BMI 

from 25 to less than 30). At the second PCP visit, 61% 

(28/46) were obese and 39% (18/46) were 

overweight. Of enrollees with higher than normal BMI (25 or above) at the first PCP who also 

had a second PCP, 10% (4/40) had a categorical decrease in BMI (all four enrollees moved from 

Figure 3 

GHAP Health Outcome Categories 

 Body mass index or 

o Overweight 25-29.9 

o Obese 30-39.9 

o Morbidly Obese >40 

 Glucose or 

o Increased risk 100-125

o Diabetes >126 

 Blood Pressure

o P re -hype rte ns ion 120-139/8 0 -8 9

o St a ge 1 140 -159 />90 

o Stage 2 >160/>90 

 Lipids: 

o Total >240 

o LDL >160 

o Triglycerides >150 
15

obese to overweight). Significant differences were found in the BMI of males and females for 

those who are overweight or obese. A larger sample size is needed to examine differences 

further. 

Are enrolled individuals who use social media more likely to change behaviors than participants not 

using social media? 

Data from the three month follow-up survey shows that 42% (21/ 50) of surveyed participants received 

text messages and/or emails as a part of GHAP; 50% (7/14) received text message and/or emails 

according to the six month follow-up survey. 

When asked in the three month survey if the text and emails were motivational to change behaviors, (of 

respondents who received text/emails): 24% (5/21) said somewhat; 33% (7/21) said quite a bit; 24% 

(5/21) very motivational. For 6 month survey respondents who received text/emails, 71% (5/7) said 

somewhat, 14% (1/7) said quite a bit and 14% (1/7) said very motivational (Figure 4). 

Figure 4: Participants’ Assessment of Motivational Value of Text/Email Messages 

0%

10%

20%

30%

40%

50%

60%

70%

80%

Very motivating Quite a bit

motivating

Somewhat

motivating

Not motivating

At 3 months (n=21)

At 6 months (n=7)

As Figure 4 indicates, the 3 and 6-month surveys showed different patterns of response. Overall, it 

appears that enthusiasm for the text/email message component of GHAP decreased over time. 

Additional data from future surveys will be important to increasing understanding of the response to 

this intervention strategy and if it plays a role in participant behavior change. 
16

Was there a difference in health outcomes based on the type of practice (community clinic, private 

non-profit, other)? 

Both PCPs used by participants in the GHAP program are community clinics that offer services on a 

sliding fee scale. Of the 21 enrollees with categorical decreases in blood pressure from the first PCP visit 

to the second, 48% (10/21) went to Open Access and 67% (14/21) went to Shawnee. Of those with 

numerical decreases in blood pressure, 45% (10/22) went to Open Access and 55% (12/22) went to 

Shawnee. 

Of the five enrollees with categorical decreases in diabetes from the first PCP visit to the second, 40% 

(2/5) went to Open Access and 60% (3/5) went to the Shawnee. Of those with numerical decreases in 

HbA1c levels, 64% (9/14) went to Open Access and 36% (5/14) went to the Shawnee. 

Of the 4 enrollees with categorical decreases in BMI from the first PCP visit to the second, 75% (3/4) 

went to Open Access and 25% (1/4) went to Shawnee. Of those with numerical decreases in BMI levels, 

72% (18/25) went to Open Access and 28% (7/25) went to Shawnee. 

While the number of participants described in the previous section on differences in health outcomes by 

practice type is small, the results may signal the beginning of positive results, particularly for those 

receiving care from Open Access. Future data will provide more evidence to review. 

Findings for GHAP to date are summarized in Tables 3 and 4, which list evaluation questions, indicators, 

data sources, and current measurements. Descriptive statistics of active enrollees are available in 

Appendix A. 
17

Table 3: GHAP Preliminary Findings: Implementation

Evaluation Question Indicator Data Source Current Measurement

1. Was GHAP implemented as planned 

regarding participant enrollment and 

participant retention? 

a. Did the enrolled group engage 

in the program interventions as 

planned?

a. # of screenings that occurred vs. # planned 

i. BMI (1,500)

ii. Blood Pressure (1,500)

iii. Glucose (250)

iv. Cholesterol (250)

b. # of individuals enrolled vs. planned (300 year 1; 300 

year 2)

c. # and % of enrolled participants who were retained in 

the program vs. goal

d. # enrolled individuals:

i. Participating in the group or individual

intervention

ii. Currently receiving community resources:

1. YMCA

2. Tobacco cessation 

3. YMCA Diabetes Prevention

4. Norton Healthcare programs

5. Other

e. Currently using social media

i. Text

ii. Emails

f. Contacted by phone for 3-month data collection (of 

those who were able to be surveyed; those 

consenting on Jan. 31, 2013 or before)

g. Contacted for 6-month in-person data collection (of 

those who were able to be surveyed; those 

consenting on Oct. 31, 2012 or before)

h. Contacted by phone for 12-month data collection

i. Via information from PCP

Program 

records; KHFI 

quarterly 

reports; 

screening intake 

and follow-up 

surveys; PCP 

follow-up data 

Actual (4/2012 –3/2013):

a. 4,516 

i. 2,582

ii. 3,655

iii. 928

iv. 256

b. 28%(211/750) initial enrollees

c. 18% (134/750) activeenrollees

d. Enrolled:

i. 44 completed group or 

individual intervention

ii. Community Resources 

(contains duplicates—19 

individuals responded they use 

community resources):

1. 14 (YMCA/exercise 

prog.)

2. 0 (Tobacco Cessation)

3. 1 (Diabetes 

Prevention)

4. 1 (Norton Program)

5. 1 (Diet Program)

6. 3 (Other)

e. Currently using social media

i. 42% (21/50)said they received 

text or emails at the 3 month 

survey; 50% (7/14)at 6 months 

f. 44% (50/114) (completed 3 month 

survey)

g. 17% (14/83) (completed 6-month 

survey)

h. 12-month data not available yet

i. 98% (131/134) (Information from PCP)
18

2. How much variation in implementation 

fidelity was there?

a. On what aspects of implementation 

was the greatest variation?

a. Where staff felt there was the greatest variation in 

GHAP’s intervention.

Major differences of GHAP as implemented from the 

program’s workplan, such as:

b. # of enrolled

a. # of enrolled individuals participating in each 

intervention

b. # of enrolled individuals participating in social media

Staff focus 

group 

conducted June 

3, 2013

Screening events in conjunction with another 

event were more successful. The number 

enrolled at the end of year one was lower 

than expected; comorbidity of population 

higher than expected. Group interventions 

were not as popular as expected. Facebook 

not as popular as expected. 

3. What factors contributed to successful 

program participation or completion?

a. Environmental and program elements that clients felt 

helped them to participate successfully in the 

program.

b. Environmental and program attributes that staff 

feel helped participants succeed in the program.

12-month 

follow-up 

survey (not yet 

available)

Staff focus 

group 

conducted June 

3, 2013

Participant data not yet available. 

Staff identified success factors as: Optimistic 

and flexible staff that were able to make 

changes and solve problems quickly. 

Connections made between enrollees and 

GHAP staff through interventions, phone 

calls, and text messages kept participants 

engaged. Participants appreciate the service 

and have a need for it. 

4. What barriers prevented successful 

program participation or ability to 

complete the program?

a. Environmental and program elements that clients 

perceived as barriers to successful program 

participation.

b. Environmental and program attributes that staff 

perceived as barriers to successful program 

participation.

12-month 

follow-up 

survey (not yet 

available)

Staff focus 

group 

conducted June 

3, 2013

Participant data not yet available. 

Staff identified barriers as: Some of the 

population may havecontextual and 

environmental issues, such as substance 

abuse and mental illness that prevent 

enrollment. Participants not eligible due to 

having other illnesses, having a PCP, or other 

reasons. Enrollees unable to participate in 

group interventions due to limited time or no 

childcare. Program elements seen as barriers 

include waiting for IRB approval and getting 

information to and from PCPs.
19

Table 4: GHAP Preliminary Findings: Impact

Evaluation Question Indicator Data Source Current Measurement

1. To what extent has the health care 

navigation model been successful?

a. To what extent did enrolled 

individuals make contact 

with primary care medical 

providers?

b. To what extent did enrolled 

individuals make suggested 

lifestyle changes (e.g. diet, 

exercise, avoidance of 

tobacco) after beginning 

this program?

c. To what extent did health 

outcomes targeted by this 

project improve for 

participants?

a. #/and % enrolled met with PCP at least once

i. Community Medical Associates

ii. Community clinics

b. #/and % of surveyed who met with PCP during 

each follow-up period?

c. #/ and % of surveyed that indicated that 

meeting with a PCP somewhat or helped a lot 

to influence a change in healthy behaviors

d. # decreased smoking or made quit attempts?

e. # increased physical activity?

f. # increased fruit and vegetable (F/V) 

consumption?

g. # with decreases in blood pressure?

h. # with decreases in blood sugar levels?

i. # with decreases in obesity (defined by BMI or 

waist circumference)?

KHFI quarterly 

reports; Follow-up 

surveys; PCP followup data

From 4/2012 –3/2013:

a. 98% met with a PCP at least once 

(131/134)

i. 49% (64/131) Open Access

ii. 50% (66/131) Shawnee

b. 66% (33/50)--3 month; 50% (7/14) --6 

month

c. 84% (32/38 answered) at 3 month; 77% 

(10/13 answered) at 6 month

d. 0% (0/15) decreased smoking and 53% 

(8/15) made quit attempt at 3 months; 

0% (0/2) decreased smoking and 100% 

(2/2) made quit attempt at 6 months.

e. 51% (19/37) of those who answered the 

physical activity question at baseline and 

3 months had an increase in weekly 

physical activity during the past 

month.23% (3/13) of those who 

answered the physical activity question 

at baseline and 6 months had an 

increase in weekly physical activity

during the past month.

f. 37%(16/43) of those who answered the 

fruit and vegetable (F/V) question at 

baseline and 3 months had an increase 

in F/V consumption.Of those who 

answered the F/V questions at baseline 

and 6 months, 38% (5/13) had an 

increase in F/V consumption from 

baseline.
20

g. 55% (21/38) of enrollees with above 

normal BP and a 2nd PCP visit had a 

categorical BP decrease; 45% (22/49) of 

enrollees with 2nd PCP had a numerical 

decrease in both systolic and diastolic 

BP.

h. 25% (5/20) of enrollees with diabetes or 

pre-diabetes at the 1st PCP visitwho also 

had a 2nd PCP visit, had a categorical 

diabetes decrease; 33% (14/42) of 

enrollees with 2nd PCP visit had a 

numerical decrease in HbA1c level.

i. 10% (4/40) of enrollees with higher than 

normal BMI at the 1st PCP visit who also 

had a 2nd PCP visit, had a categorical BMI 

decrease; 54% (25/46) of enrollees with 

a 2nd PCP visit had a numerical decrease 

in BMI.

2. Are enrolled individuals who use social 

media more likely to change behaviors 

than participants not using social media? 

a. #/ and % of enrolled individuals who used the 

social media component of this project

b. #/ and % of enrolled individuals who report that 

social media helped them change behaviors

Follow-up survey a. 42% (21/ 50)received text/emails at 3 

month survey; 50% (7/14) received 

text/emails at 6 month survey

b. For 3 month survey respondents who 

received text/emails: 24% (5/21) said 

somewhat; 33% (7/21) said quite a bit; 

24% (5/21) very motivational

3. Was there a difference in health 

outcomes based on the type of practice 

(community clinic, private non- profit, 

other)?

For each type of provider (CMA and community 

clinic):

a. # with decreases in blood pressure?

b. # with decreases in blood sugar levels?

c. # with decreases in obesity (defined by BMI or 

waist circumference)?

PCP follow-up data a. Open Access:

a. 10 enrollees had numerical 

decrease; 7 had categorical 

decrease in blood pressure

b. 9 enrollees had numerical 

decrease; 2 had categorical 

decrease in blood sugar

c. 18 enrollees had numerical 

decrease; 3 had categorical 

decrease in BMI

b. Shawnee:
21

a. 12 enrollees had numerical 

decrease; 14 had categorical 

decrease in BP

b. 5 enrollees had numerical 

decrease; 3 had categorical 

decrease in blood sugar

c. 7 enrollees had numerical 

decrease; 1 had categorical 

decrease in BMI
22

Discussion 

After the first year of implementation of GHAP, preliminary implementation and impact evaluation 

results show many program successes and also revealed some barriers. Over 3,000 more individuals 

were screened for the program than expected and of those, 750 were eligible for enrollment. Of the 

750, 211 (28%) were initially enrolled and 134 (18%) became active enrollees. Fewer people became 

actively enrolled in the program than expected (134 versus 300) for year one. GHAP staff observed that 

participants preferred to participate in the program on an individual basis and were reluctant to enroll if 

only group sessions were offered. This pattern may be associated with potential loss of privacy in the 

group sessions. Barriers such as limited time and lack of childcare also reduced participation. However, 

enrollees did increase participation in community resources, such as YMCA, with GHAP enrollment from 

baseline (screening) to three month follow-up. 

Initial impacts of the program after year one show many successes. Nearly all of those enrolled were 

navigated to a PCP and had at least one visit. Physical activity and fruit and vegetable consumption 

increased from baseline (screening) to three month follow-up. Also, blood pressure, diabetes, and BMI 

decreased among some individuals from baseline to follow-up. At the six month follow-up point, GHAP 

staff attempt to contact participants who were not reached for the three month follow-up to collect 

follow-up data. This will occur again at the 12 month follow-up point for those who were not reached. 

Staff will attempt to reach participants three times. Strengths of the program include optimistic and 

flexible staff that are able to find solutions to problems quickly. Also the staff was able to make 

connections with enrollees through in-person meetings, phone calls, and texts or emails, which helped 

retain enrollees in the program. In addition, the team was able to develop a sustainable framework with 

clinics to provide seamless service for participants. 

Two program changes were made near the end of the first year. To increase enrollment, eligibility was 

opened to those with insurance. To retain enrollees in the program, incentives were provided to 

enrollees who complete follow-up surveys and PCP visits. Data should be monitored to determine if this 

does help to increase enrollment and retain enrollees. 
23

Appendix A 

Descriptive statistics of GHAP active enrollees (n=134)

Gender # %

Female 102 76.1

Male 32 23.9

Race

Asian 1 0.8

Black/African American 108 80.6

Native Hawaiian or 

Pacific Islander/Native 

American

1 0.8

White/Caucasian 22 16.4

More than one race 1 0.8

Refused 1 0.8

Ethnicity

Hispanic/Latino 5 3.9

Non-Hispanic 124 96.1

Age (Mean) 45 years (Range: 19 - 63)

Appendix A Table 1: Behaviors of GHAP enrollees at baseline, 3 month and 6 month follow-up

Behavior Baseline 3 Month 6 Month Base to 3 month 

change

Base to 6 month 

change

Smoking 36% 

(48/133)

30% 

(15/50)

14% (2/14)  0% (0/15) of 

smokers no 

longer 

smoking

 53% (8/15)of 

smokers 

made quit 

attempt

 0% (0/2) of 

smokers no 

longer 

smoking

 100% (2/2) of 

smokers 

made quit 

attempt

Physical 

Activity

23% 

(28/124) 

never 

physically 

active

18% (9/49) 

never 

physically 

active

0% (0/14) 

never 

physically 

active

 51% (19/37) 

increased any 

physical 

activity 

 Of 7 enrollees 

who were 

never 

physically 

active at 

baseline and 

were 

surveyed at 3 

months, 5 

increased 

23% (3/13) 

increased any 

physical activity
24

physical 

activity to at 

least some

Fruit and 

vegetable 

consumption

82% 

(108/131) 

eating less 

than 5 F/V 

per day

83% 

(39/47) 

eating less 

than 5 F/V 

per day

79% (11/14) 

eating less 

than 5 F/V 

per day 

 37% (16/43) 

had any 

increase in 

F/V 

consumption 

from baseline

 Of 41 

enrollees who 

were eating < 

5 servings of 

F/V per day at 

baseline and 

were 

surveyed at 3 

months, 7 

(17%) 

increased to 5 

or more/day

31% (4/13) had any 

increase in F/V 

consumption from 

baseline

Appendix A Table 2: Health measures for GHAP enrollees at screening, first PCP, and second PCP 

visit

Health Measure Screening First PCP 

Visit

Second 

PCP Visit

Change from 1st to 2nd PCP

Blood Pressure (BP)  55% (21/38) of enrollees with BP 

above normal who also had a 2

nd

PCP visit, had a categorical BP 

decrease 

 45% (22/49)of enrollees with 2nd

PCP visit had a numerical 

decrease in both systolic and 

diastolic BP

Hypertensive 47% 

(62/132)

50% 

(65/130)

18% 

(18/49)

Prehypertensive40% 

(53/132)

28% 

(36/130)

35% 

(17/49)

Normal 13% 

(17/132)

22% 

(29/130)

29% 

(14/49)

Blood Sugar  25% (5/20) of enrollees with

diabetes or pre-diabetes at the 

1

st PCP visit who also had a 2nd

PCP visit, had a categorical 

diabetes decrease

 33% (14/42)of enrollees with 2nd

PCP visit had a numerical 

decrease in HbA1c level

Diabetes - 8% 

(9/119)

2% 

(1/42)

Pre-diabetes - 45% 

(54/119)

55% 

(23/42)

Normal - 47% 

(56/119)

43% 

(18/42)

BMI  10% (4/40) of enrollees with 

Obese 60% higher than normal BMI at the 

(72/121)

65% 

(77/119)

61% 

(28/46)
25

Overweight 35% 

(42/121)

28% 

(33/119)

39% 

(18/46)

1

st PCP visit who also had a 2nd

PCP visit, had a categorical BMI 

decrease

 54% (25/46) of enrollees with a 

2

nd PCP visit had a numerical 

decrease in BMI

Normal 5% 

(6/121)

8% 

(9/119)

-

Waist Circumference

(WC)

Male >40 in. or 

Females >35 in.

76% 

(31/41)

50% 

(7/14) (3-

month)

57% 

(4/7) (6-

month)

7% (1/14) of enrollees with 3-month 

follow-up WC measurement had a 

decrease in numerical WC from 

screening

Appendix B 

GHAP Focus Group Summary 

On June 3, 2013, a focus group was conducted with GHAP program staff. Mark Dignan facilitated and 

Kate Jones took notes. The purpose of the focus group discussion was to gather information on the first 

year of GHAP’s implementation. Nine people who work with the GHAP program in some way 

participated in the discussion, with roles that include program assistant, nurse and lay health navigator, 

nurse practitioner, outreach coordinator, grants coordinator, strategic planning and evaluation, and 

principal investigator. Three participants were with the program since planning stages, three were with 

the program since it began (about one year and two months) and three started within one year or less. 

When asked about the biggest differences, in terms of how GHAP was implemented versus what was 

planned or expected, participants provided information about various parts of the program. First, 

turnout for screening events varied across screening sites. Staff found that screening events that were in 

conjunction with a partner hosting another event yielded more people screened than if staff were to 

hold an event on their own or with a partner and no corresponding event. One focus group participant 

stated that radio advertisements were placed early on in the program, but she did not “see where it 

impacted turnout.” Determining where to hold screening events were “trial and error” at times, 

according to another focus group participant. She and another focus group participant indicated that 

networking and developing a relationship with potential partners helped determine screening sites. 

Other staff said that the number of people enrolled is not what was expected for the one year time 

frame of the program. At the time of the focus group, there were about 219 people enrolled in GHAP. At 

one year, the group expected to have 300 enrolled in the program. One focus group participant stated 

that two barriers for enrollment include people who are not interested and people who are ineligible. 

Some people who were screened and showed interest in the program and enrolled, but did not stay 

with the program because they were not interested later. Another focus group participant said that 
26

some potential enrollees say the program “sounds good,” but are not ready and, at that point, are not 

interested in discussing it further. Also, a potential enrollee may have a disease that could be 

complicated or interfered with. Another focus group participant added that the comorbidity level is 

much higher than initially anticipated for this population. Some people screened who were considered 

to be eligible for GHAP, were actually ineligible because he or she did have a PCP, but were not going as 

frequently as needed. 

One focus group participant stated that the insurance eligibility requirement has changed, but no 

difference has been seen yet since this change has only been in the last couple of months. Other barriers 

to eligibility or being interested in enrolling are issues that are ongoing in the lives of the target 

population, such as substance abuse or mental illness. Another participant added to this, saying 

screenings in the poorest areas often have many other barriers, such as financial challenges, concern 

about the ability to pay the electric bill for example, that take priority over health. 

Another difference in GHAP’s implementation from what was expected was that group interventions 

were not as popular as expected. Individual interventions are often done on the phone, which are more 

convenient for enrollees. Another focus group participant confirmed this and said that enrollees’ needs 

are barriers for group interventions. For example, they may not have child care or have been in school 

or work all week and don’t have time. Another focus group participant said that getting to the PCP may 

be more important to the enrollee than participating in interventions. She added that the cooking demo 

intervention, where there is an intervention along with free food, is more successful. 

One other difference in the implementation of GHAP, versus what was expected, is regarding the social 

media aspect of the program. A focus group participant said that enrollees who signed up to receive text 

messages will receive one motivational text message every month and appointment reminders. Also, 

the program maintains a Facebook page and makes updates to it twice a week. A different focus group 

participant stated that there was a low turnout for Facebook, regarding the number of people who 

“like” the page. Another focus group participant added to this saying, “it’s the way social media is set up; 

if people say they like us, others would see that.” Texting is considered more private than Facebook 

where all personal information is available. 

Barriers to implementing GHAP include those described above, such as people who are not interested in 

enrolling or are ineligible due to substance abuse or other issues. Environmental or contextual issues 

that some potential participants may be dealing with in their lives may be causing them to not be ready 

or uninterested in participating. One focus group participant stated that, for enrollees, not having 

resources to do what is recommended by GHAP is a barrier. For example, often when she suggests 

exercise to enrollees, they will say they can’t afford a gym membership and she suggests exercises that 

can be done at home. Also, one focus group participant described a barrier of the program to be letting 

people know about it. She stated that there are so many things going on with the target population that 

‘rising above the noise level’ is a challenge. 

Another barrier to implementing GHAP was described by a focus group participant as an administrative 

barrier. She stated that a lot of time is taken to fax reports to PCPs. It would help if the electronic health 
27

record system were in a place where it would be easier to communicate with doctor offices so that it 

would be more “seamless.” Another administrative barrier shared by another focus group participant is 

that the IRB process slowed things down and even held the program up at times. It was somewhat of a 

challenge to keep the staff motivated. 

When asked about the biggest factors of success for the first year of GHAP, focus group participants 

stated that they felt the program has been successful because there is a need in the population and 

people appreciate the service. Another focus group participant agreed with this and said that people 

who use the program can become a better person. 

One focus group participant stated a big factor of success was the “eternal optimism of the team.” 

Someone else added to this, saying that being flexible was a success factor, where staff was able to 

make changes “on the fly.” For example, if they were trying to find a partner to hold a screening and 

things did not work out, the staff would be able to go back and reevaluate. Another focus group 

participant confirmed this and said that the strategy meetings were beneficial. 

Focus group participants also said that enrollees are likely to stay engaged in the program because of 

the connections being made between enrollees and GHAP staff each month through interventions, 

phone calls and text messaging. Data collection is not a burden for enrollees. The main data collection is 

during the screening and follow-up surveys are short. 

Focus group participants also stated that they feel the Norton Healthcare name adds value to the GHAP 

program for the target population. They feel Norton Healthcare is respected in the community. 

Looking ahead for GHAP, one focus group participant expressed optimism about the hard work from 

year one, in terms of data collection. She stated it has been labor intensive, but seeing the results is 

promising. She also felt that the program would be able to use the lessons learned from year one and 

maximize on that to move forward for year two to help those in the community. Also, she was 

encouraged by the possibilities for expansion to other areas and moving to a wider scale. Another 

participant said they thought it would be helpful for enrollees if the program were extended to help 

them after one year in terms of resources for them and checking on progress. 

Some focus group participants shared positive moments that they received from working with GHAP. 

One participant said that during a screening, they found a woman with extremely high blood pressure. 

Even though she was ineligible for GHAP, the staff were able to immediately get her across the street to 

a health clinic that was able to able to help her. Another participant shared that feedback they receive 

from people they are screening is encouraging. She said people she sees during screenings may say, 

“’Thank you,’ ‘I’m really interested,’ ‘I want to change,’ or ‘I needed to see somebody.’” Another focus 

group participant said they feel good when they call someone to check in and hear that they are working 

and making progress. Someone else said they appreciated it when a woman came to have her blood 

pressure checked at a screening and when she proceeded to tell the woman about GHAP, she already 

was enrolled. She was coming to check on her progress, so it was a good feeling to the focus group 

participant that the woman was engaging in the program and taking an interest in her health. 
28

In summary, the focus group participants are optimistic about the program and feel it is making a 

difference in a community that has a need for GHAP services. Lessons learned from year one include 

working with partners who hold community events and collaborate screening events with those, rather 

than holding them separately. Also learned from year one is that there may be contextual issues in the 

lives of some potential enrollees that may be inhibiting them from enrolling in the program. Possible 

solutions include using community resources that address these issues more. Other lessons learned 

include focusing more on individual interventions rather than group interventions, as it is more 

convenient and private for enrollees. Also, it was learned that using Facebook as a way to engage 

enrollees is not effective, but, for those who use text messaging, sending motivational text messages 

appears to be. Lessons learned for the administrative pieces of GHAP include allowing extra time for IRB 

review and approval. Success factors for year one of GHAP include an optimistic, flexible team that 

works together to plan and overcome barriers. Success is also due to the program staff making 

connections with enrollees on a regular basis, through interventions, phone calls, and text messages. 

The GHAP staff look forward to year two of the program and using what they have learned from the first 

year to improve and expand their program.