WISEWOMAN BEST PRACTICES 

TOOLKIT: 

Lessons Learned from Selected Projects 

 

Melanie Besculides 

Heather Zaveri 

Charlotte Hanson
This toolkit was developed by Mathematica Policy Research, Inc., under contract number 200-2001-

00122, with the Centers for Disease Control and Prevention, Division for Heart Disease and Stroke 

Prevention, WISEWOMAN Program. 

Printed February 2007 

View and search the WISEWOMAN Best Practices Toolkit on the web at 

http:www.cdc.gov/wisewoman/ 
Acknowledgments iii 

ACKNOWLEDGMENTS 

This publication was developed by Mathematica Policy Research, Inc. (MPR), under contract 

number 200-2001-00122, with the Centers for Disease Control and Prevention (CDC), Division of 

Heart Disease and Stroke Prevention, WISEWOMAN Program. 

MPR authors were Melanie Besculides, DrPH, Project Director; Heather Zaveri, MPP, Task Leader; 

and Charlotte Hanson, MPH, MS, Research Analyst. 

MPR thanks the members of the CDC WISEWOMAN Best Practices Study team—Julie Will, PhD; 

Rosanne Farris, PhD; Karen Gregory-Mercado, MPH, PhD; and Ryan Loo, PhD—for their 

contributions throughout each phase of the WISEWOMAN Best Practices Study. In addition, MPR 

thanks the WISEWOMAN project officers, project directors, and coordinators, as well as the staff 

at local sites who participated in the case studies that led to the development of this toolkit. MPR 

thanks Olga Khavjou, MA, and Eric Finkelstein, PhD, at RTI International for developing the site 

selection methods and selecting the case study sites. MPR thanks the National Breast and Cervical 

Cancer Early Detection Program and IMS for their assistance in the site selection. MPR greatly 

appreciates the guidance provided by the WISEWOMAN Consultant Group; the Best Practices 

Stakeholder Group; Russell Glasgow, PhD; and Ronette Briefel, DrPH.
Acknowledgments iv 

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Table of Contents v 

TABLE OF CONTENTS 

TOOLKIT OVERVIEW.................................................................................................................................1 

1. General Information About the Toolkit..................................................................... 1 

2. Target Audience........................................................................................................................1 

3. Toolkit Organization................................................................................................................1 

4. Definitions .................................................................................................................................3 

CHAPTER I: METHODS USED TO IDENTIFY BEST PRACTICES...................................5 

1. WISEWOMAN Program Background..................................................................................5 

2. WISEWOMAN Best Practices Study Background .............................................................6 

3. Case Studies ...............................................................................................................................6 

4. Best Practice Identification......................................................................................................7 

5. Caveats........................................................................................................................................7 

CHAPTER II: REACH—Participating in WISEWOMAN...................................................9 

CHAPTER III: EFFECTIVENESS—Preventing and Improving Risk Factors..................... 27 

CHAPTER IV: ADOPTION—Recruiting and Retaining WISEWOMAN Sites . ....................61 

CHAPTER V: IMPLEMENTATION—Delivering the Lifestyle Intervention .. . ....................81 

CHAPTER VI: MAINTENANCE—Sustaining WISEWOMAN..........................................95 

APPENDIX A: TOOLS FROM THE FIELD................................ . ..............................A.1 

APPENDIX B: DESCRIPTIONS OF PROJECTS INCLUDED IN STUDY. .................... ..B.1 
Toolkit Overview vi 

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Toolkit Overview 1 

 

Toolkit Overview

1. GENERAL INFORMATION ABOUT THE TOOLKIT 

Welcome to the Well-Integrated Screening and Evaluation for Women Across the Nation 

(WISEWOMAN) Best Practices Toolkit. The toolkit provides guidance, resources, and technical tools to 

help WISEWOMAN programs serve women. The described practices address recruitment and 

engagement of program participants, lifestyle intervention delivery, facilitation and maintenance of 

behavior change, and participant retention in the WISEWOMAN program. The toolkit also lists strategies 

to assist WISEWOMAN projects in recruiting and retaining local sites and in facilitating local site adoption 

of the described practices. 

The toolkit is a compendium of best program practices identified through in-depth case studies with 

selected WISEWOMAN projects. The methods used to identify best practices are outlined in Chapter I. 

The toolkit is meant as a reference guide from which projects and local sites can select practices that might 

be useful in their states or tribal organizations. The writers recognize that the practices included in this 

toolkit might not be effective in all settings; therefore, the toolkit is not meant to dictate practices that all 

projects should use. 

2. TARGET AUDIENCE 

The primary audience for the toolkit consists of Centers for Disease Control and Prevention (CDC)-

funded WISEWOMAN projects and their local sites. Programs interested in learning more about 

WISEWOMAN should contact CDC. WISEWOMAN is a trademarked brand and use of the name 

should be discussed with CDC. 

While many of the practices are specific to WISEWOMAN, it is anticipated that the toolkit will appeal to a 

broader audience. This audience includes practitioners delivering public health and health promotion 

interventions that target cardiovascular disease and provide lifestyle interventions. In addition, 

practitioners working more broadly in public health and health promotion might find adaptable practices 

in the toolkit. 

3. TOOLKIT ORGANIZATION 

The toolkit is organized around the five dimensions of the RE-AIM framework (Reach, Effectiveness, 

Adoption, Implementation, and Maintenance) developed by Dr. Russell Glasgow and colleagues.1

 The 

purpose of RE-AIM is to facilitate evaluations of the translatability and overall public health impact of a 

health promotion intervention. The framework specifies dimensions at the individual and institutional 

levels. For this study, dimensions are defined as (1) the intervention’s reach into the intended population, 

(2) its effectiveness in modifying risk, (3) its adoption by target settings, (4) its consistent 

implementation, and (5) maintenance of its effects among participants and target settings. 

1 Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM 

framework. Am J Public Health. 1999;89(9):1322-7. 
The best practices for each RE-AIM dimension are presented in Chapters II–VI. For simplicity, the 

Reach, Effectiveness, Adoption, Implementation, and Maintenance chapters are formatted in an identical 

manner. The first page of each chapter provides a definition of the RE-AIM dimension to be presented, 

an illustration of how the dimension applies to WISEWOMAN, a description of the practices that fit 

within the dimension, and an overview of the information included in the chapter. The page numbers for 

key sections of the chapter are also listed on this page. 

Starting on the second page of each chapter is a table with “Snapshots of Practices from Selected 

Projects.” In this table, the best practices are listed by category. All practices are numbered sequentially 

and subpractices are numbered to coordinate with the associated practice. For example, if a main practice 

is numbered “3,” the subpractice is numbered “3A.” Each snapshots table has columns for ProjectLevel Practice, Local-Level Practice, Page Described, and Tool Included on Page. Checkmarks in the first 

two of these columns (project- and local-level practices) indicate whether the best practice applies to the 

project-level, the local-level, or both. The page on which each practice is described in detail is listed under 

the Page Described column. If a technical tool from the field is available for a given practice, the page 

where this tool can be found is listed under the Tool Included on Page column. All tools are provided in 

Appendix A of the toolkit. 

The next pages of each chapter present Details of Practices from Selected WISEWOMAN Programs. 

Each practice is presented in this section as described in the table below. 

Practice(s) The practice or group of practices described on the page 

Description Description of the practice 

Examples of how the practice was used in the field by one or more projects. These examples were 

selected by Mathematica Policy Research, Inc. (MPR) from the sites that had appropriate examples. 

When selecting examples, MPR considered clarity of the example and ensured that all participating 

projects were represented in the toolkit. 

Examples 

from the 

Field 

 Appendix page where relevant tools shared by projects are provided, if available 

Things to 

Consider 

Potential feasibility concerns that a project should consider when implementing the practice. 

Feasibility concerns are highlighted for (1) staff level of effort, (2) staff skill level and training, (3) 

cultural adaptability, and (4) other considerations. The descriptions of staff level of effort and other 

considerations include potential activities that could result in a cost to the project or local site. 

Defining specific costs was not feasible due to the significant variation in available resources across 

projects and local sites. 

Chapter numbers, RE-AIM dimensions, and practice numbers for similar practices within the same 

chapter or in another chapter. These practices are clustered into categories, such as goal setting, 

experiential activities, incentives, partnerships, staffing, and training. 

Related 

Practices 

Contact Contact information for projects highlighted in the Examples from the Field section 

Information 

The final section of each chapter is an Action Checklist. This is another list of the practices in the chapter 

(grouped by categories) that is aimed at engaging toolkit users by encouraging them to mark practices that 

Toolkit Overview 2 
Toolkit Overview 3 

they might consider using in their project or local site. The main column in the table is labeled “Is the 

Project or Site Interested in Adopting this Strategy?” for this purpose. 

4. DEFINITIONS 

Terms frequently used in the toolkit are defined below: 

Best Practices are project or local site activities, practices, or processes that are considered successful for 

delivering WISEWOMAN program services, as indicated by quantitative measures combined with 

systematically gathered qualitative data. Best practices take into account existing variation in the program 

and policy, cultural, socioeconomic, and geographic contexts in which WISEWOMAN projects operate. 

Core Elements are central to an intervention’s theory and internal logic. Core elements are critical 

features of the intervention’s intent and should be kept intact when the intervention is implemented or 

adapted for it to produce program outcomes similar to those of the original research.2

Local-Level Practices are practices that this study identified and that are directly applicable to local sites 

delivering WISEWOMAN program services. Toolkit users who do not have WISEWOMAN projects 

might also find these practices of interest. 

Project-Level Practices are practices that this study identified and that are directly applicable to 

WISEWOMAN projects that typically operate at the state or tribal level and oversee multiple local sites. 

Toolkit users who do not have WISEWOMAN projects might also find these practices of interest. 

The RE-AIM framework was developed by Glasgow and colleagues to facilitate evaluation of the 

translatability and overall public health impact of a health promotion intervention. The framework 

identifies five dimensions (reach, effectiveness, adoption, implementation, and maintenance): 

Reach is the degree to which women participate in WISEWOMAN and their representativeness. 3

Effectiveness is the extent to which modifications in risk factors occur as a result of WISEWOMAN 

participation. 3

Adoption is the degree to which provider sites and service delivery settings adopt WISEWOMAN. 3

Implementation is the extent to which the program and its lifestyle intervention are delivered as 

intended. 3

Maintenance is the extent to which a program is sustained over time and health improvements in 

women are maintained over time. 3

 2 McKleroy VS, Galbraith J, Cummings B, Jones P, Harshbarger C, Collins C, et al. Adapting evidence-based behavioral 

interventions for new settings and target populations. Atlanta (GA): Centers for Disease Control and Prevention; 2006. 

3 Definitions of RE-AIM dimensions have been adapted to reflect the WISEWOMAN program. 
Toolkit Overview 4 

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Chapter I: Methods Used to Identify Best Practices

The detailed methods for identifying best practices have been published and are available on the 

Web http://www.cdc.gov/pcd/issues/2006/jan/05_0133.htm free of charge.4 The methods are 

described briefly below.

1. WISEWOMAN PROGRAM BACKGROUND 

The Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program 

is funded by the Centers for Disease Control and Prevention (CDC) to screen women for risk factors 

associated with cardiovascular disease, provide lifestyle interventions to encourage reduction of and change 

in behavior risk factors, establish systems for accessing needed medications, and ensure that women 

receive needed follow-up care and return for a 1-year follow-up screening. 

Congress established the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in 

1991. In 1993, Congress authorized CDC to set up WISEWOMAN as a demonstration program within 

NBCCEDP. CDC funded three WISEWOMAN demonstration projects in 1995. At the time of 

publication, 15 WISEWOMAN projects operated in 14 states across the country. 

CDC funds state and tribal organizations to develop either standard or enhanced projects. Both types of 

projects screen women for cardiovascular risk factors and administer lifestyle interventions. Enhanced 

projects also evaluate the effectiveness of lifestyle interventions by comparing outcomes for women who 

receive an enhanced intervention to women who receive a minimum intervention or usual care. At the 

time of publication, nine standard projects and six enhanced projects were operating. 

Each state or tribal project oversees a number of local sites that deliver WISEWOMAN program services. 

Participants are low-income and under- or uninsured women aged 40-64 who do not qualify for Medicaid. 

All WISEWOMAN participants also must be enrolled in the Breast and Cervical Cancer Early Detection 

Program (BCCEDP). 

All WISEWOMAN projects provide women with blood pressure and cholesterol screenings and some 

projects also screen them for diabetes and osteoporosis. In addition, all projects administer a lifestyle 

intervention targeted at improving cardiovascular disease risk factors. Projects have freedom in selecting 

an intervention that is culturally appropriate for their priority population as long as scientific evidence 

supports its effectiveness either in lowering blood pressure or cholesterol or in improving diet and physical 

activity.5

 This freedom means that projects across the country offer different interventions. In addition, 

local sites within projects often have the flexibility to modify selected characteristics of their project’s 

intervention to fit the needs of the local community in which they operate. 

 4 Besculides M, Zaveri H, Farris R, Will J. Identifying best practices for WISEWOMAN programs using a mixed-methods 

evaluation. Prev Chronic Dis. 2006;3(1):A07. Epub 2005 Dec 15. Available at: 

http://www.cdc.gov/pcd/issues/2006/jan/05_0133.htm. 

Chapter I: Methods 5 

5 Department of Health and Human Services. The heart of the matter: chronic disease prevention guidance and resources 

for WISEWOMAN projects. Atlanta (GA): Centers for Disease Control and Prevention; 2006. Available at: 

http://www.cdc.gov/wisewoman.
Chapter I: Methods 6 

 

2. WISEWOMAN BEST PRACTICE STUDY BACKGROUND 

“Best practices” is a popular term that, in the programmatic setting, refers to activities, practices, or 

processes that lead to the implementation of an intervention or other program activity using the most 

appropriate strategies for a given population and setting.6 For WISEWOMAN, best practices are project 

or local site activities, practices, or processes that are considered successful for delivering program services, 

as indicated by quantitative measures combined with systematically gathered qualitative data. Mathematica 

Policy Research, Inc. (MPR) identified best practices in selected WISEWOMAN projects. 

The goal of the WISEWOMAN Best Practices Study was to identify a set of best practices related to risk 

factor screening and the delivery of this varied set of lifestyle interventions from which existing and new 

WISEWOMAN projects could learn. The practices identified are presented in this toolkit. 

3. CASE STUDIES 

Five of the 15 WISEWOMAN projects were chosen for in-depth case study. The selected projects were 

in Massachusetts, Michigan, Nebraska, North Carolina, and Southeast Alaska Regional Health Consortium 

(SEARHC).7

 Four of these states or tribal organizations have standard projects. North Carolina has an 

enhanced project, but its research activities occur in one site and all of its other sites operate as standard 

sites. Collectively, these projects vary on multiple dimensions, including the type of local site, intervention 

delivered, and staff arrangements. 

Project selection was based on the availability of quantitative re-screening data for at least 100 women per 

local site 10 to 14 months after program enrollment. Quantitative data from each local site were used to 

calculate measures of RE-AIM. A composite RE-AIM score that measured the overall public health 

impact (success) of each local site was determined, and the two highest- and one lowest-performing sites 

within each of the five projects were selected for case study. Sites were selected through a separate CDC 

contract with RTI International. To reduce potential bias, MPR researchers conducting the case studies 

were blinded to local site performance during data collection. 

MPR collected qualitative data through review of program materials, preliminary telephone interviews with 

CDC WISEWOMAN staff and state and tribal project- and local-level staff, and site visits. Site visits were 

made to each local site and the state or tribal organization that oversaw the local sites. During site visits, 

in-person interviews were conducted with staff members who played a role in developing or delivering the 

lifestyle intervention. When possible, local program partners were also interviewed to learn about the 

staff’s perspectives on practices that were used to implement the lifestyle intervention. In one example, 

interviews were conducted with staff at a community swimming pool that offered discounted passes to 

WISEWOMAN participants as a way to increase their physical activity levels. The visits also entailed 

observations of the lifestyle intervention and focus groups with program participants. 

6 Green L. Generalizing from idiosyncratic research to “best practices” in other settings and populations. Presented at the 

Second International Symposium on the Effectiveness of Health Promotion, May 28, 2001. Toronto, Ontario, Canada: 

University of Toronto. Available at: http://www.utoronto.ca/chp/download/2ndSymposium/L.%20Green.doc. 

7 Brief descriptions of the five case study projects and their lifestyle interventions are provided in Appendix A.
4. BEST PRACTICE IDENTIFICATION 

Analysis of qualitative data involved writing site reports, developing theme tables, identifying practices of 

interest, and applying an algorithm to determine best practices. To ensure the accuracy of the data that 

were collected, site reports were verified by each site from which data were collected. Practice themes 

were then identified from the site reports. Next, potential best practices were identified from the theme 

tables through a consensus-building process between the CDC and MPR teams. The best practices 

algorithm (Figure 1) was then applied to each identified practice to assess whether it was a best practice. 

The application of this algorithm has been described in detail previously and can be viewed on the web 

http://www.cdc.gov/pcd/issues/2006/jan/05_0133.htm. 

Practice 1

Figure 1

Algorithm for Determining Best Practices in Selected WISEWOMAN Programs

Number of times 

practice was stated 

across all sites 

Performance of sites 

who stated practice 

(high versus low)

Only high-performing sites= 

Best Practice

Only low-performing sites= 

Not Best Practice

High- & low-performing sites =

Was there a difference in how high- and 

low-performing sites implemented the 

practice?

Chapter I: Methods 7 

5. CAVEATS 

To facilitate accurate interpretation of the practices described in this toolkit, we note several caveats about 

the methods used in the Best Practices Study. 

First, only projects with sufficient data for local site analysis were included in the study. Thus, projects and 

local sites not included in the study might also have best practices. The WISEWOMAN Best Practices 

Study is ongoing and, if funding permits, additional case studies will be conducted to identify more best 

practices as data become available. 

Second, high- and low-performing sites were selected based on an average composite score across the REAIM dimensions. A best practice related to a given RE-AIM dimension (e.g., Reach) could therefore be 

May Be Best Practice

Yes = 

Best Practice

No = 

May Be Best Practice

Are more than two thirds of 

sites that use practice highperforming?†

Yes = Best Practice No = Not Best Practice

† If only one high- and one low-performing site stated practice, it 

is not a best practice because only 50% who stated practice were

high-performing.
Chapter I: Methods 8 

identified from a high-performing site that had a mediocre score on the Reach dimension if its scores on 

other RE-AIM dimensions were high enough to counterbalance its Reach score. 

Third, at least one high-performing site must have used a practice for the practice to be considered a best 

practice. It is possible that a low-performing site had a good practice, but unless high-performing sites 

also used the practice, it was not considered a best practice. Both high- and low-performing sites were 

selected so that differences in how sites used the same practice could be identified. 

Fourth, we identify in the toolkit whether each practice is applicable to the project, local site, or both. In 

some cases, a practice might appear to apply to both the project and local site, but the description only 

highlights one of these levels. This reflects the methods used to collect and analyze data. A seemingly 

applicable practice might only have been identified at one of these levels during data collection, or it might 

have been identified at both levels but only met the criteria for best practice at one level. 

Fifth, best practices are listed under only one dimension (the primary dimension to which they apply) for 

clarity and simplicity. Practices could, however, apply to more than one dimension. When this is the case, 

the secondary dimension is listed in parentheses after the practice name in the section entitled Details of 

Practices from Selected WISEWOMAN Projects. 

Sixth, some of the participating projects have undergone significant transition during their period of 

funding, including a transition from enhanced to standard project. This transition could have had an 

impact on the way services are delivered. For example, during the enhanced project phase, women might 

have received a more intensive lifestyle intervention than during the period of standard operation. 

Finally, activities and examples described for some best practices were made possible through additional 

resources that the project or local site obtained from agencies other than CDC. These additional resources 

allowed sites to supplement traditional WISEWOMAN activities and provide incentives or services not 

covered by CDC funding. For instance, local sites might pay for a participant’s family members to attend 

events such as weekly swimming nights using non-CDC funds. 
 Chapter II: REACH—

Participating in WISEWOMAN 

WHAT IS REACH? 

In the RE-AIM framework, the dimension of REACH focuses 

on the process of recruiting and engaging women in 

WISEWOMAN using strategies that are culturally 

appropriate for the women served. 

WHAT TYPES OF PRACTICES ARE INCLUDED IN REACH? 

The process of developing strategies to reach eligible women 

is critical to the success of all WISEWOMAN projects. All 

women who participate in WISEWOMAN must also 

participate in BCCEDP. REACH strategies broadly cluster 

into two categories: inreach, or strategies targeted to women 

already enrolled in BCCEDP, and outreach, or strategies to 

engage new women in WISEWOMAN and BCCEDP. 

It is primarily the responsibility of local sites to successfully 

reach women; however, state and tribal projects may assist 

local sites by developing standardized materials and branding 

the program with a name or logo. Local sites reach eligible 

women by using a variety of collaborative, active, and 

informal strategies and by targeting certain ethnic groups 

using culturally appropriate strategies. Sites often work 

collaboratively with BCCEDP staff to recruit women who 

are new to both programs. They also employ active 

strategies to engage women, such as face-to-face recruitment, 

and informal strategies, such as word of mouth. Assigning 

appropriate staff to conduct recruitment activities is the key 

to success in reaching eligible women. 

From a WISEWOMAN participant 

“I take handouts [brochures] to women 

about the program to help encourage 

others to come.” 

IN THIS CHAPTER

3⁄4 Snapshots of reach strategies from 

selected projects 10 

3⁄4 Details of reach strategies from 

selected projects 12 

3⁄4 Action checklist with strategies for 

reaching women 24

Chapter II: Reach 9 
Chapter II: Reach 10 

LocalLevel 

Practice 

Page 

Described

Tool 

Included 

on Page

SNAPSHOTS OF REACH PRACTICES FROM SELECTED PROJECTS

ProjectLevel 

Practice

IDENTIFYING THE WISEWOMAN PROGRAM IN A CONSISTENT MANNER

1. Develop standardized materials for local sites to use 9 12 A.2-A.5

2. Brand the program with a logo or name 9 13 

RECRUITING AND ENGAGING WOMEN

3. Use multiple recruitment strategies to engage women 9 14 

4. Work with BCCEDP to recruit new WISEWOMAN 

participants 9 15 

4A. Employ a joint WISEWOMAN and BCCEDP 

coordinator 9 15 

5. Engage in active recruitment of new participants 9 16 

6. Conduct face-to-face recruitment with women 9 17 

6A. Approach women waiting for other appointments in the 

same clinic or hospital and attempt to recruit them if they are 

eligible 

9 17 

6B. Offer incentives to engage women in conversation about 

the program 9 17 

7. Be an active member of the clinic or hospital in which 

your program operates to encourage other providers to refer 

women to WISEWOMAN 

9 18 

8. Develop relationships with providers external to the clinic 

or hospital in which you operate, educate the providers and 

their staff about WISEWOMAN, and encourage referrals 

9 19 

9. Target appropriate community organizations, educate the 

organizations about WISEWOMAN, and encourage the 

organizations to refer women to the program 

9 19 

10. Engage in informal recruitment of new participants 9 21 

10A. Use word of mouth as a recruitment strategy by 

encouraging participants to discuss WISEWOMAN with 

other women 

9 21 

11. Invite families to selected WISEWOMAN activities 9 22 

IDENTIFYING APPROPRIATE STAFF

12. Identify staff who are an appropriate fit to conduct 

outreach and recruitment activities 

9 23
Chapter II: Reach 11 

LocalLevel 

Practice 

Page 

Described

Tool 

Included 

on Page

ProjectLevel 

Practice

12A. Use outreach staff with strong interpersonal skills 9 23 

12B. Use the same WISEWOMAN staff to recruit women 

and provide the lifestyle intervention so that the women 

recognize familiar faces 

9 23
DETAILS OF REACH PRACTICES FROM SELECTED PROJECTS 

IDENTIFYING THE WISEWOMAN PROGRAM IN A CONSISTENT MANNER

Practice(s) 1. Develop standardized materials for local sites to use (Project) 

Developing materials at the project level ensures that the description of the program and 

its services are consistent and accurate. This practice also reduces the burden on local sites 

to develop their own materials. 

Description 

Several projects have developed standardized materials for local sites to use for outreach 

and recruitment. The materials include brochures and posters that are colorful and 

represent the diverse women served by the program. 

Examples 

from the 

Field 

The Nebraska WISEWOMAN program Every Woman Matters created three brochures 

for local sites that present the same information in different languages (English, Spanish, 

and Vietnamese). Photographs of women used in each brochure represent the racial and 

ethnic backgrounds of the population targeted by the brochure. 

 Samples of Nebraska’s brochure are included in the appendix on page A.2 

Staff Level of 

Effort: 

Materials development can be time consuming for staff, as they must 

ensure that the printed messages are accurate, identify appropriate 

photographic images to include, and, often, obtain publication clearance 

from the state or tribe. 

Other 

Considerations: 

To develop standard materials for local sites, projects might take 

responsibility for printing the materials and obtaining rights to images 

included in the materials. 

Staff Skill 

Level and 

Training: 

Understanding how to market a program is beneficial when developing 

materials, as is understanding the process and requirements to publish 

materials in your state or tribal organization. If staff do not have these 

skills, training could be beneficial. 

Things to 

Consider 

Cultural 

Adaptability: 

Projects can develop materials that reflect the women served in a variety 

of ways. One brochure could include images of diverse women or, as in 

the Nebraska example, multiple brochures can be developed for 

targeted groups. 

Contact 

Information 

Every Woman Matters, Nebraska WISEWOMAN Project

Phone: 1-800-532-2227 

Chapter II: Reach 12 
Chapter II: Reach 13 

IDENTIFYING THE WISEWOMAN PROGRAM IN A CONSISTENT MANNER

Practice(s) 2. Brand the program with a logo or name (Project) 

Description To increase recognition of a program within a state or tribal area, several projects have 

branded their program with a logo or name. Logos are used on all printed letters, forms, 

documents, and incentives to help create an association between a symbol and program 

services. Logos promote quick identification of the program throughout the communities 

where they are used. Program names have been developed and marketed to women and 

their broader communities. Some projects use the name to identify both the 

WISEWOMAN and BCCED programs so that the programs are viewed as one seamless 

program. Some projects also market their program using only the WISEWOMAN name. 

When branding through a name, projects should consider incorporating 

“WISEWOMAN” into the name. 

Examples 

from the 

Field 

The project in Southeast Alaska, SEARHC, developed a logo to consistently identify its 

program. SEARHC also used the WISEWOMAN name to brand its program. Projects 

that developed a program name were Nebraska (Every Woman Matters) and 

Massachusetts (Women’s Health Network). 

Staff Level of 

Effort: 

When developing a logo or name, staff will spend time brainstorming 

and researching potential names or logos and, ideally, engaging in a 

collaborative process to ensure that the logo or name is acceptable to 

community members. 

Other 

Considerations: 

Developing a program logo or name can involve contracting out for 

logo design or a trademark. 

Staff Skill 

Level and 

Training: 

If the logo or name is developed in house, creative staff are needed. If 

legal action is required to trademark the logo, staff would benefit from 

training or experience in this area. 

Things to 

Consider 

Cultural 

Adaptability: 

While developing the logo or name, staff should consider both the 

cultural adaptability and acceptability of the name or logo to ensure that 

they will be appropriate for the women served. For example, the 

SEARHC WISEWOMAN project contracted with a local artist to 

develop a Tlingit design for its logo to represent the cultural heritage of 

many of the women enrolled in the program. 

Contact 

Information 

SEARHC WISEWOMAN Project 

Phone: 907-966-8710 (ask for WISEWOMAN Project Director) 

 

Every Woman Matters, Nebraska WISEWOMAN Project 

Phone: 1-800-532-2227 

 

Women’s Health Network, Massachusetts WISEWOMAN Project 

Phone: 617-624-5434
Chapter II: Reach 14 

RECRUITING AND ENGAGING WOMEN

Practice(s) 3. Use multiple recruitment strategies to engage women (Local) 

Description Encouraging staff to use multiple recruitment strategies allows tailoring of strategies to 

match the diversity of the women who are being recruited. The multiple strategies 

described in this chapter fall into three categories: (1) partnerships with local BCCEDP 

staff, (2) active recruitment strategies, and (3) informal approaches. Approaching women 

in a clinic waiting room and describing the program is an example of an active recruitment 

strategy. Posting flyers in a local supermarket is an example of a passive recruitment 

strategy. 

A woman shared that, “The doctor told me I qualified for WISEWOMAN. I had not noticed the 

program before .... Now I see it everywhere. I was so relieved to learn that this program will take care of 

me.”

Examples 

from the 

Field 

The WISEWOMAN program in Plymouth, Massachusetts, used a wide variety of strategies 

to recruit and engage women. These included combinations of partnerships with 

BCCEDP, active recruitment strategies, and informal approaches. Plymouth employed a 

joint coordinator and staff for WISEWOMAN and BCCEDP, thus facilitating a strong 

partnership between the programs. In addition, staff actively recruited new women by 

cultivating relationships with local providers who were both internal and external to the 

hospital where the WISEWOMAN program operated to encourage referrals. To promote 

informal recruitment, the site encouraged women to spread the word about the program to 

other potentially eligible women in the community. 

Staff Level of 

Effort: 

Developing and implementing multiple strategies to engage women that 

are both complementary in design and multifaceted in emphasis can be 

time consuming for staff. Initially, staff will spend time developing 

recruitment strategies that best meet the local site’s requirements. On an 

ongoing basis, staff will spend time assessing whether the recruitment 

strategies achieve the identified recruitment goals and revise the 

approaches if needed. 

Other 

Considerations: 

Each type of recruitment strategy will present unique considerations. For 

example, partnerships require identification of appropriate organizations 

for partnering, whereas informal approaches might require individualized 

tailoring. 

Staff Skill 

Level and 

Training: 

The process of developing and implementing a multi-pronged 

recruitment approach requires staff to understand contextual factors, 

such as the target population, feasible strategies in the community, and 

community resources. Staff might benefit from training on the research 

and available practice-based evidence related to recruiting women into 

public health and other social service interventions. 

Things to 

Consider 

Cultural 

Adaptability: 

By using multiple strategies, staff can include approaches that 

appropriately target specific ethnic groups in the area. 

Contact 

Information 

Women’s Health Network, Massachusetts WISEWOMAN Project 

Phone: 617-624-5434
Chapter II: Reach 15 

RECRUITING AND ENGAGING WOMEN

Practice(s) 4. Work with BCCEDP to recruit new WISEWOMAN participants (Local) 

4A. Employ a joint WISEWOMAN and BCCEDP coordinator (Local) 

Description According to legislation, all WISEWOMAN enrollees must participate in BCCEDP. It is 

therefore beneficial for local WISEWOMAN programs to develop relationships with 

BCCEDP for recruiting new enrollees to ensure that women participate in both programs. A 

specific recruitment strategy to employ when working with BCCEDP is to assign a joint 

program coordinator. This sets the stage for efficiently integrating the programs. In 

situations where the programs are quite large and it is too burdensome for a single staff 

member to coordinate both WISEWOMAN and BCCEDP, program coordinators can work 

together to ensure that recruitment occurs in an integrated manner. This could include 

presenting WISEWOMAN and BCCEDP as one program, discussing both programs with 

women during face-to-face outreach regardless of which program is conducting the outreach, 

or organizing joint marketing efforts for both programs. 

Examples 

from the 

Field 

A joint coordinator can work in a variety of program arrangements. Programs that are 

integrated at the project level, such as in Massachusetts and Nebraska, naturally lend 

themselves to a joint BCCEDP-WISEWOMAN coordinator arrangement at the local level. 

Joint coordinators can also be used in projects that encourage WISEWOMAN and BCCEDP 

to operate more independently, such as the North Carolina and Michigan public health 

departments and SEARHC clinics. 

Staff Level of 

Effort: 

Staff will spend time ensuring that WISEWOMAN and BCCEDP work 

together when recruiting women. The required staff time depends on 

whether or not the local site employs one coordinator for both programs. 

When one coordinator is employed, the staff person is more familiar with 

the requirements and services of each program and can employ joint 

recruitment strategies from the start. When the programs have separate 

coordinators, each coordinator will invest time in joint recruitment efforts. 

Other 

Considerations: 

Additional considerations are not anticipated. 

Staff Skill Level 

and Training: 

Local sites might seek a joint coordinator with knowledge of cardiovascular 

disease and breast and cervical cancer. The coordinator might require 

training for both programs. 

Things to 

Consider 

Cultural 

Adaptability: 

N/A 

Contact 

Information 

Every Woman Matters, Nebraska 

WISEWOMAN Project 

Phone: 1-800-532-2227 

Women’s Health Network, Massachusetts 

WISEWOMAN Project 

Phone: 617-624-5434 

 

Michigan WISEWOMAN Project 

Phone: 517-335-1178 

SEARHC WISEWOMAN Project 

Phone: 907-966-8710 (ask for 

WISEWOMAN Project Director) 

North Carolina WISEWOMAN Project 

Phone: 919-707-5301
Chapter II: Reach 16 

RECRUITING AND ENGAGING WOMEN

Practice(s) 5. Engage in active recruitment of new participants (Local) 

Description Active recruitment of new WISEWOMAN participants entails targeted and purposeful 

efforts that are specifically aimed at engaging women in the program. Strategies are 

probably specific to a local community and depend on the available resources and 

potential partnerships. When engaging in active recruitment, local staff begin by 

identifying appropriate avenues for targeted efforts. 

Potential active strategies include direct involvement with women through face-to-face 

outreach activities and targeted efforts to solicit referrals from health providers or 

community organizations. 

High-performing sites used more than one active recruitment strategy, which increased 

the likelihood that a sufficient number of women were engaged. These sites also applied 

strategies consistently over time. Six specific strategies are described in the following 

tables to illustrate identified best practices in active recruitment: 

6. Conduct face-to-face recruitment with women 

6A. Approach women waiting for other appointments in the same clinic or 

hospital and attempt to recruit them if they are eligible 

6B. Offer incentives to engage women in conversation about the program 

7. Be an active member of the clinic or hospital in which your program operates 

to encourage other providers to refer women to WISEWOMAN 

8. Develop relationships with providers external to the clinic or hospital in which 

you operate; educate the provider and its staff about WISEWOMAN and 

encourage referrals 

9. Target appropriate community organizations, educate the organizations about 

WISEWOMAN, and encourage referrals 

Examples 

from the 

Field 

Examples from the field of best practices in active recruitment are described in the tables 

for practices 6–9. 

Things to 

Consider 

Things to consider for best practices in active recruitment are described in the tables for 

practices 6–9. 

Contact 

Information 

Contact information for best practices in active recruitment is provided in the tables for 

practices 6–9. 
Chapter II: Reach 17 

RECRUITING AND ENGAGING WOMEN

Practice(s) 6. Conduct face-to-face recruitment with women (Local)

6A. Approach women waiting for other appointments in the same clinic or hospital and 

attempt to recruit them if they are eligible (Local) 

6B. Offer incentives to engage women in conversation about the program (Local) 

Description Using the active outreach strategy of targeted face-to-face recruitment allows staff to engage 

women and begin developing relationships with them. During these encounters, staff can 

provide brief or detailed program information, depending on the length of the encounter and 

each woman’s interest. 

A local staff member stated, “You must be everywhere ... helping people out.”

Examples 

from the 

Field 

Two examples of local sites that used the face-to-face approach to recruit women are the 

WISEWOMAN programs at the SEARHC clinic in Juneau, Alaska, and the Cumberland 

County Health Department in Fayetteville, North Carolina. 

The Alaska site conducted monthly “lobby events” in the clinic in which it operates. These 

events provided women with the opportunity to participate in a heart-healthy activity, such as 

a tasting low-sugar food. The events encouraged women to sample activities related to 

program goals and were used to distribute program information and recruit new participants. 

They also increased clinic staff’s awareness of the program, which aided in recruitment. 

The North Carolina site conducted face-to-face inreach by speaking with women while they 

were waiting for BCCEDP or other appointments at the health department. During these 

encounters, staff described the program and provided program brochures. In addition, staff 

distributed a small incentive, such as a heart-healthy snack, to encourage the women to 

engage in conversation. Interested women were able to enroll in WISEWOMAN and 

potentially complete the initial screening on the spot. 

Staff Level of 

Effort: 

Completing face-to-face recruitment can be time consuming for staff but 

might be an efficient use of resources if the activity leads to the recruitment 

of a large number of eligible women. 

Other 

Considerations: 

Materials and supplies, such as food and brochures, might be needed for 

lobby events. 

Staff Skill Level 

and Training: 

Staff must have organizational skills to plan and manage events and be 

knowledgeable about the topics they discuss with women. They must also 

be familiar with WISEWOMAN services to provide a detailed description 

of the program and answer questions. Furthermore, staff must be 

approachable to be effective in face-to-face outreach. 

Things to 

Consider 

Cultural 

Adaptability: 

Face-to-face contact affords staff the opportunity to conduct more tailored 

instruction that could be adapted in a culturally appropriate manner. 

Related 

Practices 

Chapter III, Effectiveness, Practice #22 

Chapter VI, Maintenance, Practice #2 

Chapter VI, Maintenance, Practice #10 

Contact 

Information 

SEARHC WISEWOMAN Project

Phone: 907-966-8710 (ask for WISEWOMAN 

Project Director) 

North Carolina WISEWOMAN Project 

Phone: 919-707-5301
Chapter II: Reach 18 

RECRUITING AND ENGAGING WOMEN

Practice(s) 7. Be an active member of the clinic or hospital in which your program operates to 

encourage other providers to refer women to WISEWOMAN (Local) 

Description Serving as an active member of the clinic or hospital in which WISEWOMAN operates is 

a strategy to increase the visibility of WISEWOMAN within the clinic or hospital. It also 

helps to build relationships between the WISEWOMAN program and other programs 

and providers and encourages other providers to refer eligible women for services. When 

applying this strategy, high-performing sites attended clinician meetings to educate staff 

about the program and regularly participated in clinic activities. 

Examples 

from the 

Field 

Two examples of local sites with staff who were active members of the hospital or clinic 

were Jordan Hospital in Plymouth, Massachusetts, and the SEARHC clinic in Haines, 

Alaska. At Jordan Hospital, both the program coordinator and risk reduction educator 

worked at the hospital for other providers prior to working for WISEWOMAN. They 

maintained their close relationships with providers at the hospital to encourage referrals 

to the WISEWOMAN program. In Haines, Alaska, the program coordinator participated 

in health fairs at the clinic and throughout the region, using these as opportunities to 

interact with other clinic staff and increase the visibility of WISEWOMAN. 

Staff Level of 

Effort: 

Staff will spend a considerable amount of time participating in activities 

in the clinic or hospital. These activities might appear to be outside of 

typical WISEWOMAN responsibilities, but they cultivate rich referral 

sources. 

Other 

Considerations: 

Additional considerations are not anticipated. 

Staff Skill 

Level and 

Training: 

The ability to quickly recognize opportunities to promote 

WISEWOMAN will be beneficial for staff. In addition, staff will 

benefit from the ability to develop and maintain collaborative 

relationships with colleagues. 

Things to 

Consider 

Cultural 

Adaptability: 

N/A 

Related 

Practices 

Chapter II, Reach, Practice #8 

Chapter II, Reach, Practice #9 

Chapter V, Implementation, Practice #7 

Chapter V, Implementation, Practice #8 

Chapter VI, Maintenance, Practice #16A/B 

Contact 

Information 

Women’s Health Network, Massachusetts WISEWOMAN Project 

Phone: 617-624-5434 

SEARHC WISEWOMAN Project 

Phone: 907-966-8710 (ask for WISEWOMAN Project Director)
Chapter II: Reach 19 

RECRUITING AND ENGAGING WOMEN

Practice(s) 8. Develop relationships with providers external to the clinic or hospital in which you 

operate, educate the providers and their staff about WISEWOMAN, and encourage 

referrals (Local) 

[Practice #8 also applies to the dimension of Adoption, Chapter IV.] 

9. Target appropriate community organizations, educate the organizations about 

WISEWOMAN, and encourage the organizations to refer women to the program 

(Local) 

Description Identifying appropriate referral sources in the community assists the local site in recruiting 

new participants. Sources can include providers external to the clinic or hospital and 

community organizations that serve the eligible population. Regardless of the source, 

local WISEWOMAN staff in high-performing sites proactively cultivated relationships. 

They also educated the full staff (such as doctors, nurses, and receptionists) about the 

program, including eligibility requirements and services provided, and gave appropriate 

assistance to ensure that the referral process was as burden free for the woman as 

possible. 

One site developed a relationship with a provider who posted flyers about 

WISEWOMAN in the office. A woman described what happened when she saw the 

flyer: “At the doctor’s office, I saw a flyer for WISEWOMAN. I asked the doctor about it; at that 

time I was paying for the exams but couldn’t really afford them. The doctor said that WISEWOMAN 

would help in paying for the exams.”

Examples 

from the 

Field 

The WISEWOMAN program at Mary Lane Hospital in Ware, Massachusetts, provides an 

example of how a local site might implement these practices. The program coordinator in 

Ware met with area doctors and their staff to educate them about WISEWOMAN and its 

services. Additionally, the program coordinator identified local organizations, such as the 

senior center, for referrals. Building relationships with local providers and organizations 

took time and required multiple face-to-face meetings to ensure staff understood the 

program and the desired referral process. To ensure that the referral process was simple, 

the program coordinator provided referral packets to providers and the organizations that 

described available services. 

Staff Level of 

Effort: 

Staff might spend a considerable amount of time developing 

relationships with providers or community organizations that are 

external to the local site. Staff time will be needed to (1) identify 

potential providers or organizations, (2) develop materials for 

distribution, (3) cultivate relationships, (4) educate providers and 

organization staff on WISEWOMAN and the requested referral 

procedures, and (5) follow up with providers and organizations to 

promote incoming referrals on an ongoing basis. 

Things to 

Consider 

Other 

Considerations: 

Depending on the requested referral approach, local sites might need to 

print materials, compile referral packets, or travel to providers or 

community organizations.
Chapter II: Reach 20 

Staff Skill Level 

and Training: 

Staff will need to feel comfortable contacting providers and 

organizations with which they might not have established relationships. 

In addition, staff will need communication skills to be able to succinctly 

describe WISEWOMAN and its services as well as to explain why 

referring eligible women to WISEWOMAN is beneficial to both 

providers and patients. 

Cultural 

Adaptability: 

Sites can seek out community organizations that serve targeted cultural 

and ethnic groups in the local area. When developing the referral 

process, sites might consider the cultural appropriateness of the 

strategy for reaching targeted women. 

Related 

Practices 

Chapter II, Reach, Practice #7 

Chapter V, Implementation, Practice #7 

Chapter V, Implementation, Practice #8 

Chapter VI, Maintenance, Practice #16A/B 

Contact 

Information 

Women’s Health Network, Massachusetts WISEWOMAN Project 

Phone: 617-624-5434 
Chapter II: Reach 21 

RECRUITING AND ENGAGING WOMEN

Practice(s) 10. Engage in informal recruitment of new participants (Local) 

10A. Use word of mouth as a recruitment strategy by encouraging participants to discuss 

WISEWOMAN with other women (Local) 

Description Informal recruitment of new WISEWOMAN participants entails encouraging the use of 

strategies that do not require extensive staff time or resources. Ideally, the strategies are 

simple and straightforward, such as using word of mouth. Employed strategies will likely 

be specific to a local community and the interests of the local staff. For example, informal 

strategies might work better in smaller, close-knit communities than in large, urban areas. 

Informal strategies have the potential to be fruitful referral sources when used in 

conjunction with other strategies. 

One participant shared that she heard of the program through a woman at church. The 

participant stated, “She told me about it and encouraged me to go and it’s the best thing I did.”

Examples 

from the 

Field 

Staff at the Goldenrod Hills Community Action in Wisner, Nebraska, conducted outreach 

activities in a 14-county area for both WISEWOMAN and BCCEDP. Most of the areas 

were small rural farming communities. The site encouraged current participants to describe 

WISEWOMAN to other women who were potentially eligible for the program as a means 

of informal recruitment. The SEARHC programs in Alaska also used informal recruitment 

strategies by encouraging women to inform others about the program. In addition, the 

program distributed incentives to women to celebrate accomplished goals. The incentives 

included tote bags, towels, and jackets with the program name and logo. When women use 

these incentives in public, other women might be encouraged to inquire and learn about the 

program. 

Staff Level of 

Effort: 

Limited staff time is anticipated to use informal strategies to recruit 

women. If informal strategies are selected by a local site, staff need to 

implement this practice consistently. For example, local sites might 

designate a particular encounter, such as the screening or lifestyle 

intervention, to encourage current participants to spread the word about 

WISEWOMAN. 

Other 

Considerations: 

Local sites might provide program materials, such as brochures and 

incentives, with the name and logo to encourage women to promote 

WISEWOMAN through word of mouth. 

Staff Skill 

Level and 

Training: 

Staff should feel comfortable encouraging women to engage in word-ofmouth recruitment for WISEWOMAN. 

Things to 

Consider 

Cultural 

Adaptability: 

Understanding the cultural backgrounds of women will help staff tailor 

informal recruitment messages appropriately. 

Related 

Practices 

Chapter III, Effectiveness, Practice #22E 

Contact 

Information 

Every Woman Matters, Nebraska 

WISEWOMAN Project 

Phone: 1-800-532-2227 

SEARHC WISEWOMAN Project 

Phone: 907-966-8710 (ask for 

WISEWOMAN Project Director)
Chapter II: Reach 22 

RECRUITING AND ENGAGING WOMEN

Practice(s) 11. Invite families to selected WISEWOMAN activities (Local) 

[Practice #11 also applies to the dimensions of Effectiveness, Chapter III, and 

Maintenance, Chapter VI.] 

Description The support that family members offer can encourage otherwise hesitant women to 

attend WISEWOMAN activities and adopt a more heart-healthy lifestyle. Opening 

activities to family members and encouraging participants to attend events with family 

members might increase the program’s reach, especially among culturally targeted groups 

that value a family approach to participation. In addition, it might be easier for women to 

attend events if their children can also attend. Emphasizing the family at program 

activities recognizes the possibility that the changes a woman adopts have an impact not 

only on the woman but also on her family. 

Examples 

from the 

Field 

The WISEWOMAN program at the SEARHC clinic in Sitka, Alaska, encouraged women 

to attend activities with a family member. The program sponsored an open-swim session 

one evening a week, and the women were permitted to bring female children of any age 

and male children under the age of 12. The program also organized frequent educational 

opportunities focused on heart-healthy topics and encouraged women to bring their 

family members to these events. 

Staff Level of 

Effort: 

Opening activities to family members will not require significant staff 

time. Staff will already be spending time to prepare for the activity 

whether or not the women invite family members. 

Other 

Considerations: 

The number of attendees participating in the activities will determine 

the types and quantity of resources needed to host the event. CDC 

WISEWOMAN funding cannot be used for family members, but 

projects or local sites may use funding from other sources. 

Staff Skill 

Level and 

Training: 

Specific skills and training are not anticipated to use this practice. 

Things to 

Consider 

Cultural 

Adaptability: 

The impetus of this practice is to recognize the importance of family in 

many cultures. 

Contact 

Information 

SEARHC WISEWOMAN Project 

Phone: 907-966-8710 (ask for WISEWOMAN Project Director) 
Chapter II: Reach 23 

IDENTIFYING APPROPRIATE STAFF

Practice(s) 12. Identify staff who are an appropriate fit to conduct outreach and recruitment activities 

(Local) 

12A. Use outreach staff with strong interpersonal skills (Local) 

12B. Use the same WISEWOMAN staff to recruit women and provide the lifestyle 

intervention so that the women recognize familiar faces (Local) 

[Practice #12B also applies to the dimensions of Effectiveness, Chapter III, and 

Implementation, Chapter V.] 

Description The staff conducting outreach activities are as important as the types of activities a local 

site offers. Staff who are outgoing and approachable will encourage a high level of 

comfort among the women being recruited. Ensuring staff continuity during the course 

of program services (recruitment, screening, and lifestyle intervention) provides women 

with familiar faces when receiving WISEWOMAN services. 

Women shared their experiences with staff working on WISEWOMAN: “The program 

coordinator is a doll! She is concerned about you and shows she cares.” “She treats you like a human 

being!” 

Examples 

from the 

Field 

The WISEWOMAN program at the Cumberland County Health Department in 

Fayetteville, North Carolina, provides an example of appropriate staff for outreach and 

recruitment activities. This site employed a part-time staff member who was primarily 

responsible for completing outreach activities. This staff member was a “people person” 

and much of her job entailed interacting with women. This staff member offered a 

consistent presence to women; she completed much of the initial engagement of women, 

was present at the lifestyle intervention session, and encouraged women to return for 

their evaluation screening 1 year after the initial screening through mail and telephone 

contact. 

Staff Level of 

Effort: 

Staff responsible for hiring will prioritize candidates based on relevant 

personality traits for outreach, such as approachability. This might 

prolong the recruitment process. 

Other 

Considerations: 

Additional considerations are not anticipated. 

Staff Skill 

Level and 

Training: 

Staff will benefit from communication and interviewing skills when 

implementing these practices. 

Things to 

Consider 

Cultural 

Adaptability: 

During staff recruitment, it is beneficial to consider candidates who are 

familiar with the cultural values of the women served. 

Related 

Practices 

Chapter IV, Adoption, Practice #6 

Chapter V, Implementation, Practice #4 

Contact 

Information 

North Carolina WISEWOMAN Project 

Phone: 919-707-5301
ACTION CHECKLIST: 

REACH - Participating in WISEWOMAN 

Is the Project or Site 

Interested in 

Adopting this 

Strategy? 

IDENTIFYING THE WISEWOMAN PROGRAM IN A CONSISTENT MANNER

1. Develop standardized materials for local sites to use 

2. Brand the program with a logo or name 

RECRUITING AND ENGAGING WOMEN

3. Use multiple recruitment strategies to engage women 

4. Work with BCCEDP to recruit new WISEWOMAN participants 

4A. Employ a joint WISEWOMAN and BCCEDP coordinator 

5. Engage in active recruitment of new participants 

6. Conduct face-to-face recruitment with women 

6A. Approach women waiting for other appointments in the same clinic or 

hospital and attempt to recruit them if they are eligible 

6B. Offer incentives to engage women in conversation about the program 

7. Be an active member of the clinic or hospital in which your program operates 

to encourage other providers to refer women to WISEWOMAN 

8. Develop relationships with providers external to the clinic or hospital in which 

you operate, educate the providers and their staff about WISEWOMAN, and 

encourage referrals 

9. Target appropriate community organizations, educate the organizations about 

WISEWOMAN, and encourage the organizations to refer women to the program 

10. Engage in informal recruitment of new participants 

10A. Use word of mouth as a recruitment strategy by encouraging participants to 

discuss WISEWOMAN with other women 

11. Invite families to selected WISEWOMAN activities 

IDENTIFYING APPROPRIATE STAFF

12. Identify staff who are an appropriate fit to conduct outreach and recruitment 

activities 

Chapter II: Reach 24 
Chapter II: Reach 25 

Is the Project or Site 

Interested in 

Adopting this 

Strategy? 

12A. Use outreach staff with strong interpersonal skills 

12B Use the same WISEWOMAN staff to recruit women and provide the 

lifestyle intervention so that the women recognize familiar faces
Chapter II: Reach 26 

THIS PAGE LEFT BLANK INTENTIONALLY FOR DOUBLE SIDED PRINTING
 Chapter III: EFFECTIVENESS—

Preventing and Improving Risk 

Factors 

WHAT IS EFFECTIVENESS? 

In the RE-AIM framework, the dimension of 

EFFECTIVENESS focuses on the intervention’s success at 

achieving its goals. In WISEWOMAN, EFFECTIVENESS

outcomes focus on prevention of and improvements in 

cardiovascular disease risk factors and adoption of a hearthealthy lifestyle. 

WHAT TYPES OF PRACTICES ARE INCLUDED IN 

EFFECTIVENESS? 

 The practices within the dimension of EFFECTIVENESS

focus on strategies that aim to enhance the delivery of the 

lifestyle intervention. Projects contribute to 

EFFECTIVENESS through the development, adaptation, and 

evaluation of the lifestyle intervention and by providing 

training and tools to local sites to ensure that the 

underlying behavior change theories are understood and 

applied by staff when delivering the lifestyle intervention. 

Projects can also solicit feedback from women on their 

experiences with the intervention, which can inform 

program improvement. Local sites contribute to 

EFFECTIVENESS by delivering the lifestyle intervention to 

women according to the project’s protocol. Intervention 

delivery activities include actively contacting women, 

helping women understand risk-related behaviors, setting 

goals, supporting women while making lifestyle changes, 

and incorporating incentives into the intervention. 

 

From a WISEWOMAN Participant 

“I was so worried about everything 

and everyone else that I had forgotten 

completely about me. So it was very 

helpful for me to have someone 

reminding me that I was worth doing 

this for and that I could pay more 

attention to what I was eating. The 

anti-stress piece was really helpful for 

me.”

IN THIS CHAPTER

3⁄4 Snapshots of effectiveness 

strategies from selected projects 28 

3⁄4 Details of effectiveness strategies 

from selected projects 31 

3⁄4 Action checklist with strategies for 

preventing and improving risk 

factors 57

Chapter III: Effectiveness 27 
Chapter III: Effectiveness 28 

LocalLevel 

Practice 

Page 

Described

Tool 

Included 

on Page

SNAPSHOTS OF EFFECTIVENESS PRACTICES FROM SELECTED PROJECTS

ProjectLevel 

Practice

DEVELOPING AND ADAPTING THE LIFESTYLE INTERVENTION

1. Ensure that the lifestyle intervention is culturally 

appropriate for the diverse populations served 9 31 

2. Gauge participant satisfaction with program services and 

use the information to revise or modify services offered 9 33 

3. Incorporate goal-setting strategies into the lifestyle 

intervention 9 9 34 

4. Incorporate experiential activities into the lifestyle 

intervention 9 9 35 

UNDERSTANDING BEHAVIOR CHANGE THEORY 

5. Ensure that appropriate behavior change theory is 

understood and applied by staff during lifestyle 

interventions and that tools are used 

9 9 37 A.6-A.7

5A. Train local staff on behavior change theories that guide 

the lifestyle intervention 9 9 37 

5B. Reinforce training on a regular basis and build on staff 

knowledge of the behavior change theory 9 9 37 

6. Develop or distribute tools that translate theory into 

practice for staff to use when working with women 9 39 A.8-A.12

7. Develop or distribute appropriate tools to monitor 

behavior changes in women 9 40 A.13

CONTACTING WOMEN FOR THE LIFESTYLE INTERVENTION 

8. Be active and persistent in reaching women for lifestyle 

interventions 9 41 

9. Offer flexibility in staff work schedules to reach women 

at different times of day 9 41 

10. Contact women multiple times to support behavior 

change 9 42 

DELIVERING THE LIFESTYLE INTERVENTION 

11. Provide women with immediate feedback to capitalize 

on teachable moments created by the screening 9 43 

12. Deliver the lifestyle intervention using appropriate adult 

learning techniques 9 44 

12A. Incorporate multiple learning styles in lessons 9 44
Chapter III: Effectiveness 29 

LocalLevel 

Practice 

Page 

Described

Tool 

Included 

on Page

ProjectLevel 

Practice

12B. Offer opportunities for experiential learning 9 44 

13. Deliver the lifestyle intervention using multiple modes 

of contact 9 45 

ENHANCING A WOMAN’S ABILITY TO MAKE LIFESTYLE CHANGES 

14. Identify the individual needs of the women served and 

ensure that the lifestyle intervention targets those needs 9 46 

15. Encourage women to set goals during intervention 

sessions 9 47 

16. Build new skills by teaching about the process of 

reaching goals 9 47 A.14-

A.18

17. Celebrate when women accomplish the goals they set 

for themselves 9 47 A.14-

A.18

17A. Identify ways for the program to celebrate goals 9 47 A.14-

A.18

17B. Teach women the importance of goals and how to 

reward themselves for achieving goals 9 47 A.14-

A.18

18. Incorporate opportunities for extra services into the 

lifestyle intervention 9 49 

19. Address women’s barriers to behavior change, focusing 

on environmental barriers 9 50 

20. Link women to free or low-cost resources that support 

behavior change and address common barriers to adopting 

healthier lifestyles 

9 50 

21. Identify resources to address access to care barriers 9 50 

USING INCENTIVES 

22. Include incentives in the lifestyle intervention 9 51 

22A. Connect incentives to individual goal setting 9 51 

22B. Provide incentives that address women’s barriers to 

behavior change 9 51 

22C. Offer incentives that encourage women to monitor 

their behavior changes 9 51 

22D. Use incentives to encourage participation in program 

activities 9 51 

22E. Develop incentives that increase program name 

recognition in the community 9 51
Chapter III: Effectiveness 30 

LocalLevel 

Practice 

Page 

Described

Tool 

Included 

on Page

ProjectLevel 

Practice

PROVIDING WOMEN WITH SUPPORT AND ROLE MODELS 

23. Incorporate systems of support for the women into the 

lifestyle intervention through contact with staff and other 

participants 

9 9 53 

24. Recognize that staff serve as role models for healthy 

lifestyle choices 9 54 

GAINING FEEDBACK FROM WOMEN 

25. Use both passive and active mechanisms to assess 

satisfaction 9 55 

25A. Assess program satisfaction at the end of education 

and counseling or support sessions 9 55 

25B. Encourage women to write success stories to 

document their satisfaction 9 55
Chapter III: Effectiveness 31 

DETAILS OF EFFECTIVENESS STRATEGIES FROM SELECTED PROJECTS

DEVELOPING AND ADAPTING THE LIFESTYLE INTERVENTION

Practice(s) 1. Ensure that the lifestyle intervention is culturally appropriate for the diverse 

populations served (Project) 

Description Providing services to women in a culturally appropriate manner is part of the foundation 

of WISEWOMAN. Ensuring that the lifestyle intervention is culturally appropriate is 

paramount as it is a key delivered service. Many projects engage in lifestyle intervention 

design or adaptation, and it is important to consider cultural appropriateness during this 

process. In addition, it is important to recognize that cultural appropriateness often goes 

beyond language translation—culturally appropriate materials, activities, and tools can be 

used to integrate relevant cultural beliefs and attitudes into the lifestyle intervention. 

Identifying the priority population(s) guides how projects should culturally adapt 

materials. For example, if a project identifies the priority population as relatively 

homogeneous, the cultural adaptation should be specific to a single population. However, 

if the project anticipates serving a variety of cultural populations, its staff need to assess 

whether one adaptation is sufficient or if the materials need adapting for several 

populations. 

Examples 

from the 

Field 

Two examples of WISEWOMAN projects that ensured that their lifestyle intervention 

incorporated culturally appropriate strategies are the Massachusetts project and SEARHC. 

The Massachusetts project primarily used the Patient-Centered Assessment and 

Counseling for Exercise and Nutrition (PACE) intervention to serve a culturally diverse 

group of women (see Appendix B for a description of PACE). When first offering 

services, the project staff anticipated needing to translate the materials into different 

languages. However, project staff quickly learned that they needed to complete a more 

extensive adaptation to best meet the cultural needs of women. Ultimately, their 

adaptation process entailed convening focus groups with participants to understand their 

needs and cultural beliefs, translating materials into several languages, and reducing the 

literacy level of the intervention materials to fifth grade. 

Unlike the Massachusetts project, SEARHC serves a relatively homogeneous population 

that primarily consists of Alaska Natives. Non-Native women served by the project 

typically possess an interest in and respect for Native culture and value the opportunity to 

engage in traditional Native events. The SEARHC project adapted the A New Leaf 

materials to reflect more typical food and activity choices for women in the region. 

Staff Level of 

Effort: 

Ensuring that the lifestyle intervention is culturally appropriate will 

require a time commitment from staff. The process of adapting the 

materials, if needed, will require a significant amount of time and will 

probably be an ongoing process. 

Things to 

Consider 

Other 

Considerations: 

The project might be responsible for the production and dissemination 

of adapted materials or obtaining outside expertise to adapt materials.
Chapter III: Effectiveness 32 

Staff Skill 

Level and 

Training: 

Lifestyle intervention development and design requires staff with skills 

and content knowledge in curriculum design, behavior change, 

cardiovascular risk factors, nutrition, and physical activity. Staff must 

also have knowledge of the cultural norms and values of their target 

population(s). Staff without these skills and knowledge would benefit 

from training. 

Cultural 

Adaptability: 

N/A 

Contact 

Information 

Women’s Health Network, Massachusetts WISEWOMAN Project 

Phone: 617-624-5434 

SEARHC WISEWOMAN Project 

Phone: 907-966-8710 (ask for WISEWOMAN Project Director)
Chapter III: Effectiveness 33 

DEVELOPING AND ADAPTING THE LIFESTYLE INTERVENTION

Practice(s) 2. Gauge participant satisfaction with program services and use the information to revise 

or modify services offered (Project) 

Description One measure of success for the lifestyle intervention is the satisfaction of program 

participants. Developing a structured mechanism to collect information on participant 

satisfaction helps ensure that this information is gathered and can be incorporated when 

modifying program services. Ways to gather this information range from simple, such as 

providing women the opportunity to report success stories following completion of the 

lifestyle intervention, to complex, such as conducting a telephone or mail survey with a 

random sample of the WISEWOMAN population. Each project can evaluate its available 

time and resources for gathering information on participant satisfaction. 

Examples 

from the 

Field 

The SEARHC project solicited feedback from women following their annual re-screening 

visits. Staff distributed a satisfaction survey that asked about positive and negative 

experiences with the program’s screening and lifestyle intervention. Women were 

encouraged to complete the survey and return it by mail to the project director in a 

postage-paid envelope provided. The project director analyzed the survey responses and 

reported findings to staff at the local sites several times each year. 

The Nebraska project encouraged local sites to solicit success stories from women to 

better understand their overall satisfaction with WISEWOMAN. Staff at some local sites 

promoted the writing of success stories by distributing return-addressed, stamped 

envelopes to women. In Kearney, Nebraska, the program coordinator estimated that the 

site received success stories from about 90 percent of program participants. In Wisner, 

Nebraska, the program coordinator received success stories on a weekly basis from 

women. 

Staff Level of 

Effort: 

The amount of staff time required will vary depending on the method 

employed to solicit information on satisfaction. More sophisticated and 

complex methods will require more time to design, analyze, and share 

results with staff. 

Other 

Considerations: 

Depending on the method used, the project might be responsible for 

the production of materials and postage. 

Staff Skill 

Level and 

Training: 

The skill level required of staff will vary depending on the method 

employed to solicit information on satisfaction. More sophisticated and 

complex methods will require a higher level of skill. If the project 

employs a complex method to solicit information, staff would probably 

benefit from training in survey and sampling design. 

Things to 

Consider 

Cultural 

Adaptability: 

N/A 

Related 

Practices 

Chapter III, Effectiveness, Practice #25 

Contact 

Information 

SEARHC WISEWOMAN Project 

Phone: 907-966-8710 (ask for 

WISEWOMAN Project Director) 

Every Woman Matters, 

Nebraska WISEWOMAN Project 

Phone: 1-800-532-2227
Chapter III: Effectiveness 34 

DEVELOPING AND ADAPTING THE LIFESTYLE INTERVENTION

Practice(s) 3. Incorporate goal-setting strategies into the lifestyle intervention (Project, Local) 

Description Goal setting is an effective strategy to promote lifestyle changes in nutrition and physical 

activity. By setting goals, women identify specific areas for change as well as the steps 

needed to achieve the change. Projects can vary their levels of emphasis on goal setting in 

the lifestyle intervention, but this strategy establishes a foundation for realistic and 

targeted individual change in women. Local sites may exercise flexibility in how they 

incorporate goal setting into the intervention and may also vary the emphasis placed on 

goal setting within the broader lifestyle intervention. 

Examples 

from the 

Field 

The Michigan WISEWOMAN project provided individual counseling sessions that aimed 

to support women in setting and working toward behavior change goals. During the 

initial session, an interventionist guided the women in selecting up to two goals that 

focused on nutrition, physical activity, or smoking cessation. Typical goals targeted 

increased fruit and vegetable intake, increased low-fat dairy product consumption, or 

increased physical activity. During subsequent counseling sessions, the interventionist 

inquired about the woman’s progress toward the identified goals and helped the woman 

strategize ways to meet the goals. 

Staff Level of 

Effort: 

Staff who work with women to set goals will spend time helping them 

to identify appropriate goals, follow up on their progress, and suggest 

new tactics to keep them working towards goals. When planning for 

lifestyle intervention delivery, projects can incorporate time for staff to 

complete goal setting with women. 

Other 

Considerations: 

Additional considerations are not anticipated. 

Staff Skill 

Level and 

Training: 

Staff need to understand behavior change theory and how goal setting 

relates to lifestyle changes in women. Also, staff would benefit from a 

background in cardiovascular disease risk factors as well as lifestyle 

change through healthy eating, physical activity, and smoking cessation. 

Things to 

Consider 

Cultural 

Adaptability: 

Goal setting is typically completed one-on-one with a woman. This 

individualized approach is well suited to meeting the cultural needs of 

the participant. For example, a one-on-one setting promotes a feeling 

of safety for women when sharing personal information. 

Related 

Practices 

Chapter III, Effectiveness, Practice #15 

Contact 

Information 

Michigan WISEWOMAN Project 

Phone: 517-335-1178
Chapter III: Effectiveness 35 

DEVELOPING AND ADAPTING THE LIFESTYLE INTERVENTION

Practice(s) 4. Incorporate experiential activities into the lifestyle intervention (Project, Local) 

Description Experiential engagement offers women the opportunity to learn through doing. By 

incorporating experiential engagement into the lifestyle intervention, projects encourage 

women to adopt healthier lifestyles through firsthand experience of the targeted behavior. 

Experiential activities can focus on either nutrition or physical activity. An example in 

nutrition is a food-tasting event that allows women to sample low-fat, low-sodium, or 

high-fiber foods. This type of activity could also offer the opportunity for food 

preparation. Walking clubs and swimming nights are examples of experiential 

engagement in the area of physical activity. 

Both projects and local sites can establish opportunities for experiential engagement. 

Projects can assist local sites by developing partnerships with organizations that offer 

opportunities for experiential encounters. If projects do not offer assistance, local sites 

can develop their own programs for women or establish partnerships with local 

organizations that offer services to women. High-performing local sites that offered 

women experiential opportunities developed and conducted multiples types of activities. 

A woman in a focus group explained the value of incorporating hands-on opportunities 

into the lifestyle intervention. She stated, “[I liked] getting to try hummus at an event. It’s 

amazing when you try something new; when you get a taste, your whole world opens up.”

Examples 

from the 

Field 

Both the Nebraska and Michigan projects have incorporated experiential engagement into 

their lifestyle interventions. In Nebraska, women who participated in the ABC Class (see 

Appendix B for a description of this program) received multiple opportunities for firsthand experiences with healthy food choices. For each class, the educator prepared a 

heart-healthy meal for the women, providing them an opportunity to taste new foods and 

gain more knowledge about portion sizes. A prepared meal might include pasta salad with 

chicken, fresh vegetables, and whole-wheat pasta or a low-sodium soup with vegetables 

and whole grains. In addition, educators actively taught women to understand the food 

label on products by incorporating label-reading activities into the classes. While 

discussing whole grains, women might have the opportunity to select a product they think 

is high in whole grains. The educator then instructs the women how to read the food 

label of the selected product to identify whether it is high in whole grains. 

At Public Health Delta and Menominee Counties in Escanaba, Michigan, the program 

coordinator organized a walking club for program participants. The club met weekly for 8 

weeks. During each meeting, program staff presented brief information on a relevant 

topic and women walked a set course with program staff. The walking club promoted 

physical activity, offered women social support while engaging in physical activity, and 

allowed program staff to develop relationships with the women. 

Staff Level of 

Effort: 

Staff will spend time preparing for and providing experiential activities. 

The amount of time spent depends on the frequency and types of 

activities. 

Things to 

Consider 

Other 

Considerations: 

Accompanying supplies and materials will be required for each activity. 

In addition, the project or local site might need to reserve a facility if the 

activity occurs offsite.
Chapter III: Effectiveness 36 

Staff Skill 

Level and 

Training: 

Required staff skill level varies depending on the activity, but generally 

staff benefit from training in lifestyle change theory and an 

understanding of cardiovascular disease risk factors. Specific training 

might be necessary for some activities. 

Cultural 

Adaptability: 

N/A 

Related 

Practices 

Chapter III, Effectiveness, Practice #12B 

Chapter III, Effectiveness, Practice #18 

Chapter VI, Maintenance, Practice #8 

Contact 

Information 

Every Woman Matters, Nebraska WISEWOMAN Project 

Phone: 1-800-532-2227 

Michigan WISEWOMAN Project 

Phone: 517-335-1178
UNDERSTANDING BEHAVIOR CHANGE THEORY

5. Ensure that appropriate behavior change theory is understood and applied by staff 

during lifestyle interventions and that tools are used (Project, Local) 

Practice(s) 

5A. Train local staff on behavior change theories that guide the lifestyle intervention 

(Project, Local) 

5B. Reinforce training on a regular basis and build on staff knowledge of the behavior 

change theory (Project, Local) 

[Practice #5B also applies to the dimension of Implementation, Chapter V.] 

Description Behavior change theory establishes the foundation for each lifestyle intervention used by 

projects. As such, the effectiveness of intervention delivery increases as staff come to 

understand the theory, its applications, and how to use related tools when working with 

women. Applying the practice typically entails training on behavior change theory and 

clear descriptions of applications, followed by project-provided training on the lifestyle 

intervention. 

Training on behavior change theory requires initial introduction and continual 

reinforcement. After staff develop an initial understanding of the theory, future training 

sessions provide the opportunity to deepen staff knowledge related to the theory and its 

application to the lifestyle intervention. 

High-performing local sites deliberately hired staff who already possessed a basic 

understanding of behavior change theories and arranged training by project or local site 

staff as well staff outside the project. These training sessions focused on understanding 

the theory and how to apply it when delivering lifestyle interventions. 

Examples 

from the 

Field 

The SEARHC WISEWOMAN project used Traditions of the Heart (see Appendix B 

for a description of this intervention) to provide one-on-one assessment and counseling 

to women related to nutrition and physical activity behavior change. Multiple theoretical 

concepts guide Traditions of the Heart, including the Stages of Change theory. When 

delivering the intervention to women, staff conducted a brief motivation-enhancing 

interview with women to determine which lifestyle behaviors they were ready to change 

and were interested in pursuing. 

To develop staff proficiency in applying motivational interviewing techniques to the 

Traditions of the Heart lifestyle intervention, SEARHC provided multiple training 

sessions on the topic. Initially, the training focused on teaching staff skills to understand 

the behavior change theory and conducting motivational interviews. Subsequent training 

sessions provided refresher courses to staff and focused more on how to combine the 

motivational interview and the Traditions of the Heart counseling technique. 

 SEARHC’s WISEWOMAN Brief Negotiation Roadmap is included in the 

appendix on page A.6 as a tool to illustrate the process for conducting a motivationenhancing interview. 

Chapter III: Effectiveness 37 
Chapter III: Effectiveness 38 

Staff Level of 

Effort: 

Preparing for and delivering initial and ongoing training requires time 

from staff, especially when ongoing training programs incorporate 

material that is different from the material provided during the initial 

training. Additional staff time is needed to assess understanding and 

application of the theory. 

Other 

Considerations: 

The project or local site might need to make logistical arrangements, 

such as reserving facilities and travel. Training might also involve 

providing tools that facilitate application of the theory. 

Staff Skill 

Level and 

Training: 

Hiring staff with a background in behavior change theory is useful. 

Providing training to all staff who deliver the lifestyle intervention will 

ensure global understanding of behavior change theory. 

Things to 

Consider 

Cultural 

Adaptability: 

N/A 

Related 

Practices 

Chapter IV, Adoption, Practice #9 

Chapter V, Implementation, Practice #5 

Contact 

Information 

SEARHC WISEWOMAN Project 

Phone: 907-966-8710 (ask for WISEWOMAN Project Director)
UNDERSTANDING BEHAVIOR CHANGE THEORY

6. Develop or distribute tools that translate theory into practice for staff to use when 

working with women (Project) 

Practice(s) 

Projects develop a variety of tools to translate behavior change theory into practice for 

participating women. Assigning this task to project staff with specialized training ensures 

that the theory is applied consistently across local sites within a project. 

Description 

Both the Nebraska and North Carolina projects developed materials that translate 

behavior change theory into practical tools for use by local staff when working with 

women. In Nebraska, the Intervention Management Log has a master key that describes 

how to use the log, defines the Stages of Change theory, and provides relevant outreach 

strategies and talking points for each stage of change. 

Examples 

from the 

Field 

The University of North Carolina at Chapel Hill developed the A New Leaf lifestyle 

intervention and accompanying materials for the North Carolina WISEWOMAN project. 

The materials include a participant binder with assessment forms and related information. 

The material draws on multiple behavior change theories and translates the theoretical 

concepts so that participants can readily understand the material. 

 Nebraska’s Intervention Management Log and Master Key are included in the 

appendix on page A.8 

Staff Level of 

Effort: 

Staff will spend time developing materials. The amount of time will 

vary depending on the nature and extent of materials. For example, a 

form requires significantly less time to develop than a binder full of 

materials. Project staff will also spend time distributing the tools and 

ensuring that local staff understand how to use them. 

Other 

Considerations: 

Development will involve the production and distribution of tools. 

Staff Skill 

Level and 

Training: 

Staff who develop the tools need to know behavior change theory and 

ways to apply the theory in practical settings. In addition, an 

understanding of the research supporting the theory is useful in 

thinking about applications. 

Things to 

Consider 

Cultural 

Adaptability: 

N/A 

Contact 

Information 

Every Woman Matters, Nebraska WISEWOMAN Project 

Phone: 1-800-532-2227 

North Carolina WISEWOMAN Project 

Phone: 919-707-5301 

Chapter III: Effectiveness 39 
UNDERSTANDING BEHAVIOR CHANGE THEORY

7. Develop or distribute appropriate tools to monitor behavior changes in women 

(Project) 

Practice(s) 

The development and distribution of tools for monitoring behavior changes help sites 

encourage women to adopt and maintain lifestyle changes. Tools are typically based on 

theory and national guidelines for monitoring the adoption of behavior changes. When 

this type of tool is incorporated into the lifestyle intervention, women learn the 

importance of tracking changes over time and come to appreciate the behavior changes 

they make. Making projects responsible for developing tools to monitor behavior change 

ensures that the tools are consistently implemented across local sites within a project. 

Description 

The lifestyle intervention used by the Michigan project emphasized goal setting. To 

encourage women to track progress toward goals they set, the project developed a 

WISEWOMAN Goal Progress Chart. The chart includes brief instructions, space for the 

women to record up to two goals, and calendars for tracking progress over 8 weeks. 

Examples 

from the 

Field 

 This chart is included in the appendix on page A.13. 

Staff Level of 

Effort: 

Staff will spend time developing materials. The amount of time will 

vary depending on the nature of the tools. A single form will require 

significantly less time to develop than a lengthy set of tools. Project 

staff will also spend time distributing the tools and ensuring that local 

staff understand how to use them. 

Other 

Considerations: 

Development will involve the production and distribution of tools. 

Staff Skill 

Level and 

Training: 

Staff who develop the tools need knowledge of behavior change theory 

and ways to apply the theory in practical settings, especially as it relates 

to monitoring. Staff also need to be familiar with national guidelines 

and the target population to ensure that the tools are consistent with 

guidelines and appropriate for the target population. 

Things to 

Consider 

Cultural 

Adaptability: 

N/A 

Contact 

Information 

Michigan WISEWOMAN Project 

Phone: 517-335-1178 

Chapter III: Effectiveness 40 
Chapter III: Effectiveness 41 

CONTACTING WOMEN FOR THE LIFESTYLE INTERVENTION

Practice(s) 8. Be active and persistent in reaching women for lifestyle interventions (Local) 

9. Offer flexibility in staff work schedules to reach women at different times of day 

(Local) 

Description Engaging women in lifestyle interventions requires proactive and persistent effort by staff, 

especially when women are contacted by telephone. Participants often have busy lives 

with multiple responsibilities, and it is important for local staff to recognize their 

schedules when engaging women in lifestyle intervention activities. A strategy to facilitate 

persistence is to offer staff flexibility in their work schedules, which promotes reaching 

women during different times of day. 

Examples 

from the 

Field 

In Nebraska, all participating women received telephone calls to discuss behavior changes 

and goal setting as part of the lifestyle intervention. Recognizing the challenges associated 

with reaching women by telephone, staff at local sites adopted a philosophy of 

persistence. Staff recognized the importance of calling women multiple times and at 

different times of day. To facilitate this persistence, local sites provided staff with 

flexibility in their work schedules to conduct telephone calls during day and evening 

hours. 

Staff Level of 

Effort: 

Staff might spend a significant amount of time reaching women to 

complete the lifestyle intervention. 

Other 

Considerations: 

Staff might need to use multiple strategies for contacting women 

because some participants might not have access to a telephone. 

Staff Skill 

Level and 

Training: 

Persistence and flexibility when delivering the lifestyle intervention does 

not require a specific skill level or training. 

Things to 

Consider 

Cultural 

Adaptability: 

N/A 

Related 

Practices 

Chapter III, Effectiveness, Practice #13 

Chapter VI, Maintenance, Practice #1B 

Contact 

Information 

Every Woman Matters, Nebraska WISEWOMAN Project 

Phone: 1-800-532-2227
Chapter III: Effectiveness 42 

CONTACTING WOMEN FOR THE LIFESTYLE INTERVENTION

Practice(s) 10. Contact women multiple times to support behavior change (Local) 

Description Adopting healthy behaviors is challenging for many women because it often requires 

changing lifelong habits. Staff at local sites can contact women on an ongoing basis to 

support them in adopting and maintaining a heart-healthy lifestyle. 

Examples 

from the 

Field 

The Nebraska and Michigan WISEWOMAN projects incorporated ongoing contact with 

women into their lifestyle interventions. In Nebraska, local staff contacted women by 

telephone six times during a 6-month period to provide support in addressing their 

behavior change goals. In Michigan, local staff contacted women three to six times each 

year to discuss progress on established goals. These contacts occurred either in person or 

by telephone, depending on the needs of the women. 

Staff Level of 

Effort: 

Contacting women multiple times requires significant time from staff. 

Other 

Considerations: 

Additional considerations are not anticipated. 

Staff Skill 

Level and 

Training: 

Staff contacting women should be clear communicators, comfortable 

on the telephone, and personable. They should also have an 

understanding of behavior change theory and motivational interviewing 

techniques. 

Things to 

Consider 

Cultural 

Adaptability: 

N/A 

Contact 

Information 

Every Woman Matters, Nebraska WISEWOMAN Project 

Phone: 1-800-532-2227 

Michigan WISEWOMAN Project 

Phone: 517-335-1178
Chapter III: Effectiveness 43 

DELIVERING THE LIFESTYLE INTERVENTION

Practice(s) 11. Provide women with immediate feedback to capitalize on teachable moments created 

by the screening (Local) 

Description Screening women for cardiovascular risk factors creates an opportunity for a teachable 

moment during which staff can provide immediate feedback to women regarding their 

results. Depending on the type of screening tests used, only some results might be 

available during the appointment. Discussing even a subset of the results with the woman 

ensures that this opportunity for discussion is not missed. 

When combining the screening with education, high-performing sites discussed individual 

screening results prior to discussing behavior changes because the screening results 

established a foundation for discussing subsequent behavior changes. 

Examples 

from the 

Field 

At the Guilford County Health Department in Greensboro, North Carolina, staff met in 

person with women once each year. During this visit, a nurse completed the required risk 

factor screening and provided education. To fully realize the potential of this in-person 

encounter, the nurse incorporated the known screening results for blood pressure, height, 

and weight into the education. Formal screening results, which include blood cholesterol 

levels, were mailed to each woman about 1 week after her screening appointment. 

Staff Level of 

Effort: 

Arranging time for staff who conduct the lifestyle intervention to meet 

with women following the screening will require planning by the local 

site. The time to provide feedback to the women is incorporated into 

the staff time needed to deliver the lifestyle intervention. 

Other 

Considerations: 

Additional considerations are not anticipated. 

Staff Skill 

Level and 

Training: 

Staff who discuss clinical screening results with women must 

understand how to interpret and explain these results using simple 

terms. They must also understand how cardiovascular disease risk 

factors can be modified. 

Things to 

Consider 

Cultural 

Adaptability: 

N/A 

Contact 

Information 

North Carolina WISEWOMAN Project 

Phone: 919-707-5301
Chapter III: Effectiveness 44 

DELIVERING THE LIFESTYLE INTERVENTION

Practice(s) 12. Deliver the lifestyle intervention using appropriate adult learning techniques (Local) 

12A. Incorporate multiple learning styles in lessons (Local) 

12B. Offer opportunities for experiential learning (Local) 

Description Adult learners benefit from teaching strategies that recognize their unique needs. Women 

might have visual, auditory, or tactile learning styles. High-performing local sites 

incorporated multiple learning styles into their in-person lifestyle interventions to ensure 

that the needs of all participants were addressed. Expanding tactile learning approaches to 

incorporate experiential opportunities, such as walking groups, provided a rich resource that 

actively engaged women in the learning process. While ensuring that materials were 

appropriate in language and literacy level, high-performing local sites paired materials with 

varied teaching techniques to meet the needs of the population served. 

A woman in a focus group discussed the benefit of experiential learning during the lifestyle 

intervention. She described her experience learning to read nutrition labels, especially for 

fat contents, on snack foods as follows: “[It] was really effective to actually see [the label] and realize 

that’s what [I’ve] been eating and putting in [my] body for all these years.”

Examples 

from the 

Field 

As part of their lifestyle intervention, the local sites in SEARHC provided women with a 

wide range of opportunities that focused on increasing their knowledge about heart-healthy 

topics or engaged them in heart-healthy activities. The local sites delivered education 

sessions to women that addressed health behavior topics of great interest. Staff emphasized 

a teaching approach that recognized the multiple learning styles of women. Approaches 

included lectures by staff or discussions among women (auditory learning style), distribution 

of materials and colorful displays (visual learning style), and opportunities to touch and 

explore materials (tactile learning style). In addition, the local sites engaged women in a 

range of experiential opportunities that promoted a heart-healthy lifestyle, including 

swimming, gardening, and strength training. 

Staff Level of 

Effort: 

Staff might spend time ensuring that the material is presented using a 

combination of visual, auditory, and tactile approaches. 

Other 

Considerations: 

Additional considerations are not anticipated. 

Staff Skill 

Level and 

Training: 

To deliver the intervention in ways that accommodate adult learning 

styles, staff need to be familiar with these techniques. If staff do not have 

this knowledge before beginning to deliver the lifestyle intervention, they 

would benefit from training. 

Things to 

Consider 

Cultural 

Adaptability: 

N/A 

Related 

Practices 

Chapter III, Effectiveness, Practice #4 

Chapter III, Effectiveness, Practice #18 

Chapter VI, Maintenance, Practice #8 

Contact 

Information 

SEARHC WISEWOMAN Project 

Phone: 907-966-8710 (ask for WISEWOMAN Project Director)
Chapter III: Effectiveness 45 

DELIVERING THE LIFESTYLE INTERVENTION

Practice(s) 13. Deliver the lifestyle intervention using multiple modes of contact (Local) 

Description Each woman participating in WISEWOMAN has different needs, interests, and 

availability. Delivering the lifestyle intervention through multiple modes of contact 

recognizes the complexity of women’s lives and allows the intervention to fit the women’s 

availability. Multiple modes of contact include in-person encounters as well as telephone 

and mail contact. 

One woman described the benefit of participating in a class and receiving supportive 

telephone calls as part of the lifestyle intervention: “When the class came along, I was just on the 

verge of not taking care of myself and it reminded me to take care of myself and that there are all these 

people out there who care about me. The telephone calls showed me this was true.” 

Another woman described her appreciation for receiving mail associated with the lifestyle 

intervention. She stated, “I just like getting mail because, to me, it’s like Christmas when you get 

these booklets that you can look through.”

Examples 

from the 

Field 

The Every Woman Matters program in Nebraska allowed women to choose whether to 

receive a telephone- and mail-based self-study lifestyle intervention or an in-person classformat lifestyle intervention. These options were based on the recognition that 

participating in a face-to-face intervention is of interest to women but not always feasible 

due to time and geographical constraints. The self-study option was more feasible for 

some women than the class format. Both options contained the same content. However, 

educators could elaborate on the content and provide hands-on opportunities during class 

time to meet the interests of participating women. 

Staff Level of 

Effort: 

This practice does not require staff to allocate additional time. Instead, 

staff will divide their time delivering lifestyle interventions using 

multiple forms of contact. 

Other 

Considerations: 

Local sites might use a variety of methods, such as telephone 

conversations or mailed letters and materials, to deliver the lifestyle 

intervention to women who cannot attend in-person sessions. 

Staff Skill 

Level and 

Training: 

Staff need to feel comfortable contacting women in multiple ways. 

Training might be required to ensure that staff feel prepared to use 

different modes of contact. 

Things to 

Consider 

Cultural 

Adaptability: 

Considering the cultural appropriateness of various forms of contact 

with respect to literacy, language, and population mobility is helpful in 

determining what modes should be used. 

Related 

Practices 

Chapter III, Effectiveness, Practice #8 

Chapter VI, Maintenance, Practice #1B 

Contact 

Information 

Every Woman Matters, Nebraska WISEWOMAN Project 

Phone: 1-800-532-2227
Chapter III: Effectiveness 46 

ENHANCING A WOMAN’S ABILITY TO MAKE LIFESTYLE CHANGES

Practice(s) 14. Identify the individual needs of the women served and ensure that the lifestyle 

intervention targets those needs (Local) 

Description WISEWOMAN projects serve a diverse group of women with a variety of concerns. By 

identifying the concerns of each woman and targeting the lifestyle intervention to her 

nutrition, physical activity, and smoking cessation needs, local staff can provide an 

individualized lifestyle intervention. High-performing local sites tailored their counseling 

to each woman, provided referrals and supported goals related to nutrition, physical 

activity, and tobacco cessation. 

During focus groups, women described how the lifestyle intervention addressed their 

individual needs. One woman said, “I eat more fruits and vegetables than before. Conversation 

helped me. I had a 7-year diet and I lost 70 pounds. Then I was at a standstill. The interventionist 

helped me to figure out that I need more exercise.” Another women stated, “I have cut back on red 

meat and fat and I have increased my exercise.” 

Examples 

from the 

Field 

The Women’s Health Network in Massachusetts provided telephone counseling to each 

woman. Local staff discussed the woman’s risk factors based on her screening results and 

identified lifestyle changes that address these risk factors. In addition, the staff offered 

targeted resources to each woman, such as a free nutrition course, free smoking cessation 

counseling, or certificates to gyms or yoga studios. The goal of offering these resources 

was to encourage the woman to adopt lifestyle changes that target her areas of interest. 

Staff Level of 

Effort: 

This practice does not require staff to allocate additional time. Instead, 

staff will spend time identifying needs and providing personalized 

services when delivering the lifestyle intervention. Time might also be 

spent forming partnerships to obtain free or reduced-cost services to 

address women’s needs. 

Other 

Considerations: 

Additional considerations are not anticipated. 

Staff Skill 

Level and 

Training: 

Staff should understand the behavior change process to ensure that the 

intervention addresses each woman’s needs. 

Things to 

Consider 

Cultural 

Adaptability: 

Personalizing the delivery of the lifestyle intervention allows staff to 

ensure that the presentation is culturally appropriate. 

Contact 

Information 

Women’s Health Network, Massachusetts WISEWOMAN Project 

Phone: 617-624-5434
ENHANCING A WOMAN’S ABILITY TO MAKE LIFESTYLE CHANGES

Practice(s) 15. Encourage women to set goals during intervention sessions (Local) 

16. Build new skills by teaching about the process of reaching goals (Local) 

17. Celebrate when women accomplish the goals they set for themselves (Local) 

17A. Identify ways for the program to celebrate goals (Local) 

17B. Teach women the importance of goals and how to reward themselves for achieving 

goals (Local) 

Description One strategy for adopting a heart-healthy lifestyle is to set goals that address specific areas 

of concern. Local staff can play a role in teaching women about the process of reaching 

goals during intervention sessions. For example, staff can educate women about factors 

that facilitate attainment of goals, such as identifying a supportive partner to encourage 

progress, and those that impede goal attainment. 

Also, staff can discuss the importance of identifying rewards for achieving goals as well as 

establishing and rewarding interim goals. Rewards that mark goal attainment can be free 

or low-cost indulgences that the woman enjoys, such as a bubble bath. Local programs 

can also reward the woman for achieving identified goals by highlighting the woman’s 

accomplishment as a success story or providing an incentive to recognize goal attainment. 

High-performing local sites provided women with incentives to celebrate behavior 

changes, encouraged women to document goal attainment by writing success stories, and 

taught women how to self-reward behavior change. 

Examples 

from the 

Field 

Goal setting was included in the lifestyle interventions offered by the SEARHC and 

Massachusetts projects. In SEARHC, women had an opportunity to set goals during the 

initial lifestyle counseling session as well as during follow-up and educational meetings. A 

health educator at the Juneau, Alaska, site developed a goal-setting form that asks women 

to identify a goal, steps to achieve the goal, a supportive partner to facilitate goal 

attainment, potential barriers and strategies to overcome the barriers, and a self-reward for 

achieving the goal. On request, staff provided additional support after the initial session 

through in-person or telephone contact to assess progress toward the goal and to 

brainstorm ways to overcome barriers the woman encountered. 

The WISEWOMAN program at Jordan Hospital in Plymouth, Massachusetts, also 

encouraged women to identify goals that support a heart-healthy lifestyle. The project 

asked women to track their progress toward these goals. To facilitate tracking, staff at the 

local site developed monitoring forms for the most common goals—increasing physical 

activity, eating five fruits and vegetables a day, and adopting a low-fat diet. Along with 

the monitoring forms, staff provided a tip sheet that educates women on a given topic 

and reinforces the importance of adopting the targeted heart-healthy behavior. Staff 

asked women to return the completed tracking forms and sent women an incentive to 

celebrate goal attainment. 

 The goal-setting form used in SEARHC and the tracking forms used in Plymouth, 

Massachusetts, are included in the appendix on page A.14. 

Chapter III: Effectiveness 47 
Chapter III: Effectiveness 48 

Staff Level of 

Effort: 

This set of practices relates to how the lifestyle intervention is delivered. 

The practice requires that staff allocate a portion of the time they spend 

delivering the intervention to goal setting. 

Other 

Considerations: 

Local sites can provide women with rewards and incentives to celebrate 

the goals they achieve. 

Staff Skill 

Level and 

Training: 

Staff who deliver the lifestyle intervention should understand the goalsetting process, the role it serves in lifestyle changes, and strategies for 

using goal setting to achieve behavior changes. 

Things to 

Consider 

Cultural 

Adaptability: 

Goal setting is personalized (which includes ensuring cultural 

appropriateness) to meet the needs of each woman. 

Related 

Practices 

Chapter II, Effectiveness, Practice #3 

Contact 

Information 

SEARHC WISEWOMAN Project 

Phone: 907-966-8710 (ask for WISEWOMAN Project Director) 

Women’s Health Network, Massachusetts WISEWOMAN Project 

Phone: 617-624-5434
Chapter III: Effectiveness 49 

ENHANCING A WOMAN’S ABILITY TO MAKE LIFESTYLE CHANGES

Practice(s) 18. Incorporate opportunities for extra services into the lifestyle intervention (Local) 

Description A strategy for encouraging women to adopt a heart-healthy lifestyle is to provide ongoing 

opportunities to engage in physical activity and learn about heart-healthy nutrition. 

Offering these additional services reinforces the healthy behaviors promoted by 

WISEWOMAN. Because these are optional activities, women may use them based on 

their abilities and interests. High-performing local sites offered a wide variety of choices 

for women to increase the likelihood that women would find a topic of interest. 

Examples 

from the 

Field 

Local WISEWOMAN programs in the Michigan project offered additional opportunities 

to women that encouraged the adoption of a heart-healthy lifestyle. The sites in District 

Health Department 10 offered women a variety of opportunities that targeted smoking 

cessation and physical activity. Women who expressed an interest in smoking cessation 

received referrals to the state quitline and for nicotine replacement therapy. In addition, 

staff provided a guide to area recreation opportunities and walking trails to women who 

expressed an interest in physical activity. 

At the Public Health Delta and Menominee Counties in Escanaba, Michigan, staff offered 

women the opportunity to participate in heart-healthy activities. Staff coordinated a twosession grocery store tour that included education about heart-healthy food choices and a 

tour of a local grocery store to help women locate these foods. The site also offered a 

weekly walking group to interested women. 

Staff Level of 

Effort: 

The amount of staff time required varies depending on how the local 

site incorporates extra services. If local staff provide the services, they 

will need to allocate time to coordinating and delivering the services. If 

local staff provide referrals for extra services, less time will be required. 

Other 

Considerations: 

Local staff who deliver services might need to provide related materials, 

supplies, and facilities. 

Staff Skill 

Level and 

Training: 

If the local staff provide the services, the staff will benefit from content 

knowledge in the area of the service. If the local staff primarily 

provides referrals, they will benefit from a solid knowledge of resources 

available to women in the community. 

Things to 

Consider 

Cultural 

Adaptability: 

When planning extra services, staff should consider the cultural 

appropriateness of the service. Also, staff can identify events of 

particular interest to the cultural groups targeted by the local site. 

Related 

Practices 

Chapter III, Effectiveness, Practice #4 

Chapter III, Effectiveness, Practice #12B 

Chapter VI, Maintenance, Practice #8 

Contact 

Information 

Michigan WISEWOMAN Project 

Phone: 517-335-1178
Chapter III: Effectiveness 50 

ENHANCING A WOMAN’S ABILITY TO MAKE LIFESTYLE CHANGES

Practice(s) 19. Address women’s barriers to behavior change, focusing on environmental barriers (Local) 

20. Link women to free or low-cost resources that support behavior change and address 

common barriers to adopting healthier lifestyles (Local) 

21. Identify resources to address access to care barriers (Local) 

Description Women experience a variety of barriers that impede their ability to adopt heart-healthy 

behaviors. Local sites can address environmental barriers, such as weather, safety, or 

transportation, by encouraging physical activity around the home or by providing 

opportunities for indoor physical activity through free and reduced-price memberships to 

local gyms. Cost and the lack of access to affordable medical care are also barriers that can 

limit the adoption of heart-healthy choices. High-performing sites offered women multiple 

opportunities to address barriers as well as long-term resources. In addition, high-performing 

sites followed up with women to ensure that they took advantage of referrals. 

One woman described the benefit of receiving referrals through WISEWOMAN: “The referrals 

were the best part for me; without the referrals, I would not have done anything.” 

Examples 

from the 

Field 

The WISEWOMAN program at Mary Lane Hospital in Ware, Massachusetts, illustrates how a 

local site can address many of the barriers women face when making behavior changes. Staff 

at this site provided women access to indoor physical activity opportunities through free and 

discounted certificates to area gyms. The staff also coordinated multiple opportunities for free 

support, such as informing women of a multi-session nutrition course offered at the hospital, 

tobacco cessation support provided by program nurses, and a monthly WISEWOMAN 

support group. The WISEWOMAN support group offered women the opportunity to 

discuss heart health in a safe environment. The program’s nurse coordinator facilitated the 

group but encouraged women to take ownership of the group to ensure that it met their 

needs. In addition, the site recognized the barriers women face in affording necessary 

medications and identified available community resources to assist the women. 

Staff Level of 

Effort: 

To effectively address barriers, staff will need to allocate a portion of their 

time during the lifestyle intervention to barrier identification and strategies 

to address each barrier. Staff will also need to spend time identifying 

community resources that could address the most common barriers. 

Other 

Considerations: 

Additional considerations are not anticipated. 

Staff Skill 

Level and 

Training: 

Staff will benefit from understanding the types of barriers women 

experience and from knowing the resources available in the community. 

Staff also need appropriate skills to effectively discuss barriers with women. 

Things to 

Consider 

Cultural 

Adaptability: 

When discussing potential barriers, staff will need to consider the cultural 

appropriateness of ways to overcome the barriers discussed. 

Related 

Practices 

Chapter VI, Maintenance, Practice #11 

Chapter VI, Maintenance, Practice #15 

Contact 

Information 

Women’s Health Network, Massachusetts WISEWOMAN Project 

Phone: 617-624-5434
Chapter III: Effectiveness 51 

USING INCENTIVES

Practice(s) 22. Include incentives in the lifestyle intervention (Local) 

22A. Connect incentives to individual goal setting (Local) 

22B. Provide incentives that address women’s barriers to behavior change (Local) 

22C. Offer incentives that encourage women to monitor their behavior changes (Local) 

[Practice #22C also applies to the dimension of Maintenance, Chapter VI.] 

22D. Use incentives to encourage participation in program activities (Local) 

22E. Develop incentives that increase program name recognition in the community 

(Local) 

Description Providing incentives to women who participate in WISEWOMAN is a common practice 

in many projects. Incentives are useful and serve multiple purposes. High-performing 

local sites understood this and took time to explain each incentive’s purpose to women 

during encounters. 

One purpose of incentives is to support the goals that women set during the lifestyle 

intervention. These incentives are offered to either encourage or reinforce adoption of 

goals or reward goal achievement. An example is a water bottle or walking reflector to 

support achievement of physical activity-related goals. 

Another purpose of incentives is to help overcome women’s barriers to behavior change. 

These incentives are offered to reduce common barriers to the adoption of a heart-healthy 

lifestyle, such as the costs associated with joining a gym. 

Programs also use incentives that assist women in monitoring their behavior changes, 

such as distributing pedometers to women to support their use of the 10,000 Steps®

program. When providing these incentives, staff at high-performing sites gave one-onone attention to ensure that the women knew how to use the self-monitoring tools. 

Incentives are also distributed to women to encourage participation in program activities. 

For example, the program might distribute a pin or other piece of jewelry to women 

during each screening visit. Over time, the women might look forward to receiving the 

incentives and attending the annual screening appointments. High-performing local sites 

explained the purpose of these incentives during in-person encounters. 

A final reason for distributing incentives is to increase recognition of the program in the 

community. Incentives developed for this purpose need to display the program name 

visibly and be something that women will carry with them. Tote bags, jackets, towels, and 

water bottles with the program name are examples of incentives that increase program 

visibility. 

During focus groups, one woman described an incentive that was connected to her 

individual goals: “I got vegetarian recipes and a good cookbook .... I like to eat as little meat as I can 

and the cookbooks were helpful. I also learned ways to get more fiber.”
Chapter III: Effectiveness 52 

Examples 

from the 

Field 

The WISEWOMAN project in Southeast Alaska incorporated incentives that serve a 

variety of purposes. To promote physical activity and help reduce financial barriers to 

physical activity, local sites offered women free swimming sessions at community pools. 

To encourage participation in the swimming sessions, local sites recorded attendance each 

week. After attending a specified number of sessions, women earned a towel with the 

WISEWOMAN logo which they could use at future swimming sessions. The incentive 

also served to increase recognition of the program in the community and to reinforce 

positive behavior. 

The SEARHC project also distributed jewelry to women during each screening visit. The 

project developed several pins, each of which depicts traditional Alaska Native artwork. 

Each woman received a pin that corresponded to the number of years she participated in 

WISEWOMAN. Women could anticipate receiving a new piece of jewelry at each annual 

screening appointment. 

In addition to the towel and jewelry, SEARHC distributed other incentives that fulfilled a 

variety of purposes. The incentives have included tote bags, cutting boards, pedometers, 

water bottles, and stress-reduction balls. 

Staff Level of 

Effort: 

To ensure that incentives are used for the desired purposes within the 

lifestyle intervention, staff will spend time selecting incentives that serve 

a relevant purpose and explaining the purpose to participants. Staff 

might also allocate time to designing, purchasing, and distributing 

incentives. 

Other 

Considerations: 

Local sites can purchase and distribute different types and quantities of 

incentives. 

Staff Skill 

Level and 

Training: 

Staff providing the lifestyle interventions will benefit from 

understanding the intended purpose of each incentive. 

Things to 

Consider 

Cultural 

Adaptability: 

When selecting incentives, staff need to consider the cultural 

appropriateness of the incentives, given the population served by the 

project. 

Related 

Practices 

Chapter II, Reach, Practice #6B 

Chapter II, Reach, Practice #10A 

Chapter VI, Maintenance, Practice #2 

Chapter VI, Maintenance, Practice #10 

Contact 

Information 

SEARHC WISEWOMAN Project 

Phone: 907-966-8710 (ask for WISEWOMAN Project Director)
Chapter III: Effectiveness 53 

PROVIDING WOMEN WITH SUPPORT AND ROLE MODELS

Practice(s) 23. Incorporate systems of support for women into the lifestyle intervention through 

contact with staff and other participants (Project, Local) 

[Practice #23 also applies to the dimension of Maintenance, Chapter VI.] 

Description A strong system of social support is important in facilitating behavior change. Both staff 

and other participants can serve as support systems for women. Through ongoing 

contact, staff can encourage women to adopt and maintain lifestyle changes. During 

group intervention and education sessions, participants offer support to each other by 

discussing common challenges and successes. 

During focus groups, women described the benefit of social support from other 

participants and staff members. One woman stated, “When I’m walking with the walking 

class, I find I must be accountable.” Another woman who received supportive phone calls 

from WISEWOMAN staff said, “The outreach worker makes me feel like I’ve known her forever, 

even though I’d never met her [before].”

Examples 

from the 

Field 

The Every Woman Matters program in Nebraska offered women the choice of either a 

class-format or self-study lifestyle intervention. Both interventions incorporated social 

support with the content covered. The class-format intervention was typically conducted 

during four sessions with the same group of women. Through this regular contact, 

women developed relationships with each other and the cooperative extension educator 

who taught the class. With both the class-format and self-study intervention options, 

women received telephone calls from outreach staff to discuss progress on identified 

goals. This ongoing contact promoted the development of trusting relationships between 

program staff and participants. 

Staff Level of 

Effort: 

Staff who serve as a support system for women might contribute a 

significant amount of time to this activity. The amount of time will vary 

depending on the needs of each woman. Staff might also spend time 

cultivating a system for support among women. 

Other 

Considerations: 

Additional considerations are not anticipated. 

Staff Skill 

Level and 

Training: 

Providing support requires patience, compassion, and empathy from 

staff. A specific skill level or training background is not required. 

Things to 

Consider 

Cultural 

Adaptability: 

N/A 

Related 

Practices 

Chapter VI, Maintenance, Practice #12 

Contact 

Information 

Every Woman Matters, Nebraska WISEWOMAN Project 

Phone: 1-800-532-2227
Chapter III: Effectiveness 54 

PROVIDING WOMEN WITH SUPPORT AND ROLE MODELS

Practice(s) 24. Recognize that staff serve as role models for healthy lifestyle choices (Local) 

Description Role models can illustrate how to make healthy lifestyle choices when others observe and 

discuss their personal experiences. Through interaction with participants, staff can model 

making positive choices in physical activity and healthy eating, and participants can learn 

how to apply these choices in their own lives. Program staff at high-performing sites 

modeled healthy behaviors that were directly related to program objectives, such as food 

choices and physical activity. 

Examples 

from the 

Field 

Staff in SEARHC understood the benefit of being role models for participants and 

attempted to provide women with positive illustrations of heart-healthy living. Local sites 

in SEARHC offered free swimming sessions for WISEWOMAN participants on a weekly 

basis. The health educator in Sitka, Alaska participated in these swimming events 

whenever possible to provide an example of being physically active. The local sites also 

offered a biweekly strength-training class for participants that staff organized and taught. 

By leading the class, staff modeled physical activity for the women and developed 

relationships through frequent contact. In Haines, Alaska, the health educator organized 

a community garden with participants, which encouraged participants to engage in 

physical activity while growing fresh vegetables. 

Staff Level of 

Effort: 

Staff will spend time participating in activities with women that model 

healthy behaviors. 

Other 

Considerations: 

Additional considerations are not anticipated. 

Staff Skill 

Level and 

Training: 

Role modeling does not require special skills or training, but staff 

should be cognizant that the heart-healthy behaviors they practice 

influence participating women. 

Things to 

Consider 

Cultural 

Adaptability: 

The manner in which staff model a healthy lifestyle can reflect the 

targeted cultural background of the women served. 

Contact 

Information 

SEARHC WISEWOMAN Project 

Phone: 907-966-8710 (ask for WISEWOMAN Project Director)
Chapter III: Effectiveness 55 

GAINING FEEDBACK FROM WOMEN

Practice(s) 25. Use both passive and active mechanisms to assess satisfaction (Project) 

25A. Assess program satisfaction at the end of education and counseling or support 

sessions (Project) 

25B. Encourage women to write success stories to document their satisfaction (Project) 

Description By assessing participant satisfaction with the lifestyle intervention, projects can measure 

program success objectively. Participant satisfaction can be identified through formal and 

structured means as well as through passive methods. Formal methods can include a 

structured survey that women complete at a specific point in time. Passive methods can 

include encouraging women to write success stories that illustrate the program’s benefits. 

In many WISEWOMAN programs, the lifestyle intervention concludes before the woman 

is due for her annual screening appointment. The end of the lifestyle intervention 

provides an opportunity to assess satisfaction. It is likely that the women have engaged in 

multiple contacts with the program at this point and have had an opportunity to 

contemplate its messages and recommendations. The fact that the women are still 

engaged in program services can increase their likelihood of response. 

Success stories provide anecdotal evidence of how the lifestyle intervention has affected 

the lives of the women. These stories illustrate what the women have valued during their 

participation and focus on their priorities, challenges, and achievements. Projects can use 

success stories to understand the types of behavior changes women adopt. 

Examples 

from the 

Field 

The Nebraska and SEARHC projects solicited feedback on participant satisfaction. In the 

SEARHC project, staff asked women to complete a structured survey after the annual reenrollment visit and return it using a postage-paid envelope. The survey included 

questions about the experience with lifestyle counseling, attendance at experiential and 

educational gatherings, and lifestyle changes that the woman or her friends and family 

have made as a result of WISEWOMAN. All returned surveys were sent to the project 

director, who analyzed the results and used them to guide program improvement. 

To understand the impact of the program on women’s lives, the Every Woman Matters 

program in Nebraska encouraged women to submit success stories after completing the 

lifestyle intervention. For this purpose, local sites provided a structured form and a 

postage-paid envelope. In addition, cooperative extension educators who delivered the 

class-format lifestyle intervention assessed satisfaction using an evaluation form 

distributed at the end of the class. 

Staff Level of 

Effort: 

Developing and implementing a system to assess satisfaction and 

analyzing information from the system to guide program improvement 

requires staff time. 

Other 

Considerations: 

Projects can produce and distribute survey tools to assess satisfaction. 

Things to 

Consider 

Staff Skill Level 

and Training: 

Staff require a background relevant to the type of feedback system 

developed. For example, if a formal survey is used, staff would benefit 

from understanding survey design and research methodology. 
Chapter III: Effectiveness 56 

Cultural 

Adaptability: 

N/A 

Related 

Practices 

Chapter III, Effectiveness, Practice #2 

Contact 

Information 

SEARHC WISEWOMAN Project 

Phone: 907-966-8710 (ask for WISEWOMAN Project Director) 

Every Woman Matters, Nebraska WISEWOMAN Project 

Phone: 1-800-532-2227
ACTION CHECKLIST: 

EFFECTIVENESS—Preventing and Improving Risk Factors 

Is the Project or Site 

Interested in 

Adopting this 

Strategy? 

DEVELOPING AND ADAPTING THE LIFESTYLE INTERVENTION

1. Ensure that the lifestyle intervention is culturally appropriate for the diverse 

populations served 

2. Gauge participant satisfaction with program services and use the information 

to revise or modify services 

3. Incorporate goal-setting strategies into the lifestyle intervention 

4. Incorporate experiential activities into the lifestyle intervention 

UNDERSTANDING BEHAVIOR CHANGE THEORY 

5. Ensure that appropriate behavior change theory is understood and applied by 

staff during lifestyle interventions and that tools are used 

5A. Train local staff on behavior change theories that guide the lifestyle 

intervention 

5B. Reinforce training on a regular basis and work to build on staff knowledge of 

the behavior change theory 

6. Develop or distribute tools that translate theory into practice for staff to use 

when working with women 

7. Develop or distribute appropriate tools to monitor behavior changes in 

women 

CONTACTING WOMEN FOR THE LIFESTYLE INTERVENTION 

8. Be active and persistent in reaching women for lifestyle interventions 

9. Offer flexibility in staff work schedules to reach women at different times of 

day 

10. Contact women multiple times to support behavior change 

DELIVERING THE LIFESTYLE INTERVENTION 

11. Provide women with immediate feedback to capitalize on teachable moments 

created by the screening 

12. Deliver the lifestyle intervention using appropriate adult learning techniques 

12A. Incorporate multiple learning styles in lessons 

Chapter III: Effectiveness 57 
Chapter III: Effectiveness 58 

Is the Project or Site 

Interested in 

Adopting this 

Strategy? 

12B. Offer opportunities for experiential learning 

13. Deliver the lifestyle intervention using multiple modes of contact 

ENHANCING A WOMAN’S ABILITY TO MAKE LIFESTYLE CHANGES 

14. Identify the individual needs of the women served and ensure that the 

lifestyle intervention targets those needs 

15. Encourage women to set goals during intervention sessions 

16. Build new skills by teaching about the process of reaching goals 

17. Celebrate when women accomplish the goals they set for themselves 

17A. Identify ways for the program to celebrate goals 

17B. Teach women the importance of goals and how to reward themselves for 

achieving goals 

18. Incorporate opportunities for extra services into the lifestyle intervention 

19. Address women’s barriers to behavior change, focusing on environmental 

barriers 

20. Link women to free or low-cost resources that support behavior change and 

address common barriers to adopting healthier lifestyles 

21. Identify resources to address access to care barriers 

USING INCENTIVES 

22. Include incentives in the lifestyle intervention 

22A. Connect incentives to individual goal setting 

22B. Provide incentives that address women’s barriers to behavior change 

22C. Offer incentives that encourage women to monitor their behavior changes 

22D. Use incentives to encourage participation in program activities 

22E. Develop incentives that increase program name recognition in the 

community 

PROVIDING WOMEN WITH SUPPORT AND ROLE MODELS 

23. Incorporate systems of support for women into the lifestyle intervention 

through contact with staff and other participants 

24. Recognize that staff serve as role models for healthy lifestyle choices 

GAINING FEEDBACK FROM WOMEN 

25. Use both passive and active mechanisms to assess satisfaction 
Chapter III: Effectiveness 59 

Is the Project or Site 

Interested in 

Adopting this 

Strategy? 

25A. Assess program satisfaction at the end of education and counseling or 

support sessions 

25B. Encourage women to write success stories to document their satisfaction 
Chapter III: Effectiveness 60 

THIS PAGE LEFT BLANK INTENTIONALLY FOR DOUBLE SIDED PRINTING
C hapter IV: ADOPTION—

Engaging and Retaining 

WISEWOMAN Sites 

WHAT IS ADOPTION? 

In the RE-AIM framework, the dimension of ADOPTION

addresses implementation of a program in targeted 

settings by identifying the absolute number, proportion, 

and representativeness of settings whose leaders are 

willing to initiate a program or intervention. For 

WISEWOMAN, the goals of ADOPTION are to provide 

initial training to deliver program services and to 

promote local site retention. Associated practices and 

strategies focus on how projects engage local sites when 

beginning program operations. Within a state 

WISEWOMAN project, the ultimate goal for ADOPTION 

is implementing a state-wide program; within a tribal 

project, the ultimate goal is providing services in areas 

that are accessible to all eligible women. 

WHAT TYPES OF PRACTICES ARE INCLUDED IN 

ADOPTION? 

Developing effective strategies to engage and train sites is 

vital for the success of the program. As recipients of 

funding from the CDC, projects play a major role in 

selecting local sites and bringing them on board with the 

WISEWOMAN program. Projects also contribute to the 

retention of local staff after the site has adopted the 

program. Specifically, projects are instrumental in 

gaining staff buy-in at local sites, offering staff training, 

and fostering communication. Local sites often exert 

more control over program staffing because they select 

the appropriate staff to work with the local population 

and encourage staff commitment to WISEWOMAN. 

3⁄4 Snapshots of adoption strategies 

from selected projects 62 

3⁄4 Details of adoption strategies from 

selected projects 64 

3⁄4 Action checklist with strategies for 

engaging and retaining 

WISEWOMAN sites 78

IN THIS CHAPTER

Chapter IV: Adoption 61
Chapter IV: Adoption 62

LocalLevel 

Practice 

Page 

Described

Tool 

Included 

on Page 

SNAPSHOTS OF ADOPTION PRACTICES FROM SELECTED PROJECTS

ProjectLevel 

Practice

PROMOTING SITE AND STAFF BUY-IN

1. Provide clear expectations to local sites of program and 

service-delivery process 9 64 

2. Promote and foster buy-in among staff at local sites 9 9 65 

2A. Engage local sites in program planning 9 65 

2B. Emphasize to local staff the importance of adapting 

the lifestyle intervention to meet the needs of women 9 65 

3. Ensure that local sites are able to complete the 

paperwork used for reporting 9 67 

4. Develop an initial plan for implementation but revise 

this plan as needed 9 68 

5. Develop staff protocols that maximize percentage of 

time and resources staff spend on WISEWOMAN duties 9 69 

SELECTING AND ARRANGING STAFF

6. Encourage high levels of commitment among staff 

working in WISEWOMAN programs 9 70 

6A. Maximize percentage of work time allocated to 

WISEWOMAN duties (versus duties for other programs) 9 9 70 

7. Identify staff members who are an appropriate fit for 

WISEWOMAN 9 71 

7A. Hire staff with educational backgrounds that match 

service delivery arrangement 9 9 71 

7B. Hire staff members who can speak the appropriate 

language to work with the population of women served 9 71 

7C. Recognize the importance of appropriate interpersonal 

skills in staff as well as training, previous experience, and 

educational background 

9 9 71 

7D. Match interests of staff to their roles in 

WISEWOMAN 9 71 

TRAINING LOCAL SITE STAFF TO DELIVER WISEWOMAN

8. Train multiple staff in the procedures for 

WISEWOMAN but limit the number of staff trained to 

deliver the lifestyle intervention 

9 9 73 

9. Offer staff regular training opportunities 9 74 

9A. Promote training on nutrition, physical activity, 

smoking cessation, goal setting, and other areas relevant to 

behavior change 

9 74 

PROMOTING COMMUNICATION
Chapter IV: Adoption 63

LocalLevel 

Practice 

Page 

Described

Tool 

Included 

on Page 

ProjectLevel 

Practice

10. Promote regular communication between project staff 

and staff at local sites 

9 75 A.19-

A.21

10A. Establish systems for two-way communication 

initiated by either the project or local sites 

9 75 

10B. Provide ongoing forums for communication among 

local sites 

9 75 

11. Engage in brainstorming and strategizing discussions 

with local sites 

9 76 

12. Proactively address local site barriers to delivering 

WISEWOMAN services 

9 76 

13. Increase communication among local site staff within 

local sites and across local sites within a project 

9 77 
Chapter IV: Adoption 64

DETAILS OF ADOPTION STRATEGIES FROM SELECTED PROJECTS

PROMOTING SITE AND STAFF BUY-IN

Practice(s) 1. Provide clear expectations to local sites of program and service-delivery process 

(Project) 

Description Expectations, such as performance goals and the program philosophy, can be 

communicated to sites through training and discussion. Training sessions, manuals, and 

explanations of how to use lifestyle intervention documents help local sites understand 

the process of service delivery. Projects that communicate clear expectations to local sites 

about the program and the service-delivery process help ensure that program staff are 

prepared to deliver services as designed. 

Examples 

from the 

Field 

In Nebraska, the Every Woman Matters program set performance goals for lifestyle 

intervention participation. Local sites offered a class for which the project expected 65 

percent of enrolled women to participate and a self study intervention involving 

supportive phone calls and educational materials for which the goal was 35 percent of 

enrolled women. For each of these lifestyle interventions, staff are provided with training 

modules or manuals to understand the delivery process. 

Staff Level of 

Effort: 

Clearly outlining service-delivery protocols and developing forms and 

training modules to assist local sites in understanding service delivery 

expectations will take time at the onset of program services. Staff will 

also contribute time, both initially and on an ongoing basis, to train staff 

at local sites to deliver WISEWOMAN services. 

Other 

Considerations: 

To inform local sites of program expectations and operations, the 

project might initially invest in the development of training modules. 

Project staff might also travel to local sites to provide training. 

Staff Skill Level 

and Training: 

Staff who train local site staff will require appropriate presentation skills 

and knowledge of both the program expectations and associated 

content. 

Things to 

Consider

Cultural 

Adaptability: 

N/A 

Contact 

Information

Every Woman Matters, Nebraska WISEWOMAN Project 

Phone: 1-800-532-2227 
Chapter IV: Adoption 65

PROMOTING SITE AND STAFF BUY-IN

Practice(s) 2. Promote and foster buy-in among staff at local sites (Project, Local) 

2A. Engage local sites in program planning (Project) 

2B. Emphasize to local staff the importance of adapting the lifestyle intervention to meet 

the needs of women (Project) 

Description Promoting and fostering buy-in among local staff is achieved at the project and local 

levels. Projects can increase local staff buy-in in two ways. First, they can provide local 

sites the opportunity to be involved and invested in program design and to adapt the 

lifestyle intervention to meet the needs of the women they serve. Local sites involved in 

program planning can describe their experience and, ideally, these contributions will 

result in service delivery that meets local needs. Second, projects can provide a 

structured lifestyle intervention with a consistent set of core elements, yet allow for local 

changes to the intervention’s characteristics to accommodate site nuances. This can lead 

to less local staff frustration. For example, projects can solicit feedback early on and 

incorporate suggestions into protocol decisions, or projects can involve local staff in 

lifestyle intervention revisions after initial development. 

For local sites, staff buy-in can be achieved through staff interaction and conversation 

about programmatic issues; these interactions often take the form of meetings or 

informal encounters. Through meetings and collaboration, staff at high-performing local 

sites built interpersonal connections by fostering a team approach to serving women. 

Examples 

from the 

Field 

One project that engaged local sites in program planning is the Michigan WISEWOMAN 

project. After the project developed its lifestyle intervention and trained local sites on 

how to deliver it, the project coordinator collected feedback from trained local staff and 

this was incorporated into the final lifestyle intervention. Staff at local sites offered a 

unique and essential perspective because of their direct involvement with the women 

served. 

In Massachusetts, the Women’s Health Network implemented an intervention that 

included a structured component as well as an opportunity for community customization. 

The project required local sites to use the PACE intervention, but local sites could 

identify additional opportunities that support women in making lifestyle changes, such as 

support group sessions or nutrition education courses. The project required approval of 

all additional services identified to ensure they address the program goals of 

WISEWOMAN. 

WISEWOMAN program staff at the Public Health Delta and Menominee Counties in 

Escanaba, Michigan, sought to build a team approach among lifestyle counselors in the 

program. Three lifestyle counselors contributed different areas of expertise (dietetics, 

health education, and nursing), and they informally learned from each other by sharing 

recommendations based on their backgrounds and areas of expertise. 

Things to 

Consider

Staff Level of 

Effort: 

Initial lifestyle intervention design might require staff time to 

incorporate local feedback. The review and approval of site 

adaptations to the program service delivery might also be time 

consuming. It might take time to inform and train all local sites on 

changes. 
Chapter IV: Adoption 66

Other 

Considerations: 

If input is solicited from sites after materials have been produced, the 

project might have to produce and distribute revised materials. 

Staff Skill Level 

and Training: 

Incorporating feedback and making changes require appropriate 

content knowledge of the lifestyle intervention, including an 

understanding of the intervention’s core elements and adaptable 

characteristics and an understanding of local contexts. Designing a 

more formal means to receive feedback (such as a questionnaire or 

administrative form) might also require relevant skills. 

Cultural 

Adaptability: 

N/A 

Related 

Practices 

Chapter V, Implementation, Practice #2 

Contact 

Information

Michigan WISEWOMAN Project 

Phone: 517-335-1178 

Women’s Health Network, Massachusetts WISEWOMAN Project 

Phone: 617-624-5434 
Chapter IV: Adoption 67

PROMOTING SITE AND STAFF BUY-IN

Practice(s) 3. Ensure that local sites are able to complete the paperwork used for reporting (Project) 

Description Some amount of paperwork is necessary for documenting, monitoring, and reporting 

program services. Projects can provide training to local sites on the paperwork required. 

If local sites face barriers in completing paperwork, such as insufficient time available or 

unclear expectations, the project can provide technical assistance to address these 

barriers. If possible, the project should revise the forms to simplify the reporting 

process. Developing a streamlined reporting approach makes it easier for local sites to 

complete paperwork accurately and return it to the project in a timely manner. 

Examples 

from the 

Field 

The Michigan WISEWOMAN project provided in-person training to local staff on how 

to complete all required forms. Over time, the project has also solicited and responded 

to feedback on reporting expectations. Sites expressed concern about burdensome and 

repetitive forms. The project responded by reviewing reporting requirements and 

developing a single form that collects all needed information. In addition, the project 

changed the name of a form used in their intervention from “Lifestyle Contract” to 

“Healthy Lifestyle Goals” after receiving feedback from the local sites that women had 

reacted adversely to the word “Contract.” 

Staff Level of 

Effort: 

Projects are required to report semi-annual data elements to CDC for 

all participating women. To facilitate this, project staff train local staff 

and provide technical assistance related to reporting requirements and 

associated paperwork on an ongoing basis. Initially, project staff will 

spend time ensuring that local staff understand how to use the forms 

and report the needed information. Over time, project staff might 

revise their forms and ensure that local staff continue to complete the 

paperwork accurately. 

Other 

Considerations: 

Form changes may result in re-printing and re-distributing forms. 

Staff Skill 

Level and 

Training: 

Staff who conduct training on completing paperwork and provide 

technical assistance are expected to be well versed in program 

procedures, possess good communication skills to receive and provide 

feedback, and conduct quality assurance to ensure accuracy in local site 

reporting. In addition, it is beneficial if staff can listen to participants 

and adjust material based on their reactions. 

Things to 

Consider

Cultural 

Adaptability: 

N/A 

Contact 

Information

Michigan WISEWOMAN Project 

Phone: 517-335-1178
Chapter IV: Adoption 68

PROMOTING SITE AND STAFF BUY-IN

Practice(s) 4. Develop an initial plan for implementation but revise this plan as needed (Local) 

Description Lifestyle intervention protocols developed by the project provide structure that ensures 

that local sites deliver the intervention as intended. Local site situations can evolve as 

resources or funding change, which might require sites to revise characteristics of the 

intervention, such as how services are delivered. Local sites might find it beneficial to 

remain flexible and revise the intervention’s characteristics, as needed. Over time, highperforming sites revised their plans to provide additional services that more fully 

supported women as they make lifestyle changes. 

Examples 

from the 

Field 

In Fayetteville, North Carolina, at the Cumberland County Public Health Department, 

the lifestyle intervention originally consisted of individual counseling sessions. Over 

time, the project allowed the local site to deliver the counseling session in a small group 

format to address frequent no-shows at individual appointments. This adaptation 

became feasible when the local program obtained more space, including a small room 

for group sessions. Local staff and participants reported that the small groups 

maintained the advantages of privacy and personal attention yet also offered social 

support and a fun atmosphere. 

Staff Level of 

Effort: 

Local staff will contribute time to assess how to revise implementation 

and ensure that program expectations continue to be met. 

Other 

Considerations: 

Additional considerations depend on the type and extent of revisions. 

Staff Skill 

Level and 

Training: 

Staff should posses the ability to observe and critically reassess how a 

plan is progressing. Revisions to an implementation plan might entail 

new activities, for which local staff should be trained. 

Things to 

Consider

Cultural 

Adaptability: 

Revisions to the lifestyle intervention protocol might incorporate 

elements designed to address the unique cultural circumstances of 

targeted populations. 

Contact 

Information

North Carolina WISEWOMAN Project 

Phone: 919-707-5301 
Chapter IV: Adoption 69

PROMOTING SITE AND STAFF BUY-IN

Practice(s) 5. Develop staff protocols that maximize percentage of time and resources staff spend on 

WISEWOMAN duties (Project) 

Description Projects might be able to increase local staff commitment by developing protocols that 

maximize the percentage of time and resources required for WISEWOMAN staff. 

Project protocols will define local staff roles and the type of background required for 

each role. It is likely that staff, such as local coordinators and lifestyle intervention 

personnel, are qualified to carry out program duties and activities that are not 

WISEWOMAN related. However, where possible, limiting the extent of multitasking 

across programs or assignment of staff to multiple programs can help to maximize the 

attention given to WISEWOMAN. 

Examples 

from the 

Field 

The SEARHC project in Alaska maximized the percentage of time that staff spend on 

WISEWOMAN. SEARHC’s protocol required that each local site have a two-person 

staff team, including a patient educator with a clinical background and a health educator 

with a community health background. In addition, the staffing arrangement was such 

that educators in local sites completed only WISEWOMAN duties, with the exception of 

one patient educator who shared her time between WISEWOMAN and BCCEDP due to 

the size of the community served. 

Staff Level of 

Effort: 

Projects will need to allocate staff time to carefully develop protocols 

that maximize staffing commitment while considering local realities. 

Staff might need to revise protocols over time, which would require 

additional time. 

Other 

Considerations: 

Additional considerations are not anticipated. 

Staff Skill 

Level and 

Training: 

Developing program protocols will require staff with skills to 

understand the range of program requirements and local feasibility. 

Staff who develop protocols will need training on federal and project 

expectations to consider during protocol design. 

Things to 

Consider

Cultural 

Adaptability: 

Staff protocols can specify required staff knowledge or expertise related 

to cultural groups served. 

Contact 

Information

SEARHC WISEWOMAN Project 

Phone: 907-966-8710 (ask for WISEWOMAN Project Director) 
Chapter IV: Adoption 70

SELECTING AND ARRANGING STAFF

Practice(s) 6. Encourage high levels of commitment among staff working in WISEWOMAN 

programs (Local) 

6A. Maximize percentage of work time allocated to WISEWOMAN duties (versus duties 

for other programs) (Project, Local) 

Description Local management staff can encourage their front-line staff to maintain a commitment 

to their WISEWOMAN responsibilities by arranging staff hours to correspond to their 

program duties. Projects can also encourage local sites to have committed local staff. 

Committed staff have fewer diversions from WISEWOMAN activities. 

Examples 

from the 

Field 

In Fayetteville, North Carolina, at the Cumberland County Health Department, the 

WISEWOMAN program encouraged staff commitment by maximizing the percentage 

of work time allocated to program duties. Although the local coordinator shared her 

time between WISEWOMAN and another program, she maximized her 

WISEWOMAN time by devoting 4 full days to WISEWOMAN and 1 day to the other 

program each week. This schedule ensured that WISEWOMAN was her primary focus 

on those days. When working on WISEWOMAN, she was responsible for delivering a 

range of services, including screening, the lifestyle intervention, participant outreach, and 

coordination of the flow of patients and services. 

Staff Level of 

Effort: 

Project. Staff might spend time designing a protocol that helps sites 

maximize staff commitment. 

Local. Management staff will spend time organizing staff 

responsibilities. Additional time might also be spent selecting staff 

members who are able to carry out a greater range of WISEWOMAN 

activities. 

Other 

Considerations: 

Additional considerations are not anticipated. 

Staff Skill 

Level and 

Training: 

Project. Coordinating protocols with local sites to arrange staff in a way 

that maximizes the focus on WISEWOMAN will require 

organizational and communication skills. 

Local. To maximize the commitment of current staff, the site might 

need to train staff on new skills so that they are able to carry out a 

greater number of WISEWOMAN responsibilities. 

Things to 

Consider

Cultural 

Adaptability: 

N/A 

Contact 

Information

North Carolina WISEWOMAN Project 

Phone: 919-707-5301 
Chapter IV: Adoption 71

SELECTING AND ARRANGING STAFF

Practice(s) 7. Identify staff members who are an appropriate fit for WISEWOMAN (Local) 

7A. Hire staff with educational backgrounds that match service delivery arrangement 

(Project, Local) 

7B. Hire staff members who can speak the appropriate language to work with the 

population of women served (Local) 

7C. Recognize the importance of appropriate interpersonal skills in staff as well as 

training, previous experience, and educational background (Project, Local) 

7D. Match interests of staff to their roles in WISEWOMAN (Local) 

Description Staff are vitally important to the success of WISEWOMAN because they interact with 

the women directly. Projects play a role in encouraging local sites to hire staff with 

appropriate skills for delivering the lifestyle intervention, including an educational 

background suited to service delivery and appropriate interpersonal skills, such as being 

warm and friendly, being a good listener, and being familiar with the community. 

Often, the local site determines which staff members will deliver services. 

Characteristics to consider when selecting staff include professional and educational 

backgrounds that align with services offered and language skills that match those of the 

women served. Other personal traits are also important to consider when selecting staff, 

such as an expressed interest in the program mission, connections with the community, 

and a caring attitude. This combination of education, language skills, and interpersonal 

skills can help increase program participation and improve the quality of interaction with 

women. 

Examples 

from the 

Field 

Projects in Massachusetts and Alaska had protocols that assist local sites in choosing 

appropriate staff for WISEWOMAN. In Massachusetts, the project encouraged local 

sites to select staff with specific training. The local coordinator was expected to have a 

clinical background and possess cultural sensitivity. For example, the screening clinician 

was a nurse or physician, and the risk reduction educator and case manager was a nurse 

or dietitian. At SEARHC in Alaska, the staff model required a two-person team. One 

team member was a health educator with a background in community health or a person 

who had completed SEARHC’s community wellness advocate training (12-credit 

training program). The other team member was a clinician. Health educators who had 

completed the community wellness advocate training were valued because they were 

typically local residents and familiar with the Alaskan Native culture. 

The WISEWOMAN program at Jordan Hospital in Plymouth, Massachusetts, had a 

team of staff members with complementary characteristics. Each staff member’s role 

was clearly defined, with qualities that enhanced their ability to carry out services. For 

example, the nurse who provided education by telephone had a professional and 

educational background with specialized training in cardiovascular disease, along with 

strong interpersonal skills. A Portuguese-speaking medical interpreter, who was also a 

recruiter, helped translate educational telephone sessions through three-way calling. As a 

woman of Brazilian descent, she was also valued for gaining women’s trust. 
Chapter IV: Adoption 72

Staff Level of 

Effort: 

Employing appropriate staff is a cost that the local site must cover. 

Sites might increase the time they spend hiring staff if they are also 

emphasizing an appropriate staff fit. It is not anticipated that the 

project will spend much time developing and drafting guidelines for 

local sites to hire staff with appropriate educational backgrounds and 

skills. 

Other 

Considerations: 

Additional considerations are not anticipated. 

Staff Skill Level 

and Training: 

Depending on the nature of the lifestyle intervention, local sites might 

emphasize different skills in the staff hired. The project does not 

require specific skills to develop guidelines for local sites to hire staff 

with appropriate educational backgrounds and skills. 

Things to 

Consider

Cultural 

Adaptability: 

Hiring staff who speak the language of the women served and staff 

who have an interest in the program because of their connection to 

the community will increase the cultural adaptability of the program. 

Related 

Practices 

Chapter II, Reach, Practice #12 

Chapter V, Implementation, Practice #4 

Contact 

Information

Women’s Health Network, Massachusetts WISEWOMAN Project 

Phone: 617-624-5434 

SEARHC WISEWOMAN Project 

Phone: 907-966-8710 (ask for WISEWOMAN Project Director) 
Chapter IV: Adoption 73

TRAINING LOCAL SITE STAFF TO DELIVER WISEWOMAN

Practice(s) 8. Train multiple staff in the procedures for WISEWOMAN but limit the number of 

staff trained to deliver the lifestyle intervention (Project, Local) 

Description Project and local staff can offer training on WISEWOMAN procedures to all staff but 

they may limit training on the lifestyle intervention to certain staff members. It is 

beneficial to train all WISEWOMAN staff on procedures to increase staff 

understanding, investment, and cooperation in the program. Limiting specialized 

training, such as counseling or education techniques, to those delivering the intervention 

encourages sites to assign only appropriately trained staff to this role. 

Examples 

from the 

Field 

In Michigan, the state project coordinator provided on-site training to all local staff who 

worked on WISEWOMAN, mainly on program structure and procedures. Training that 

was specific to lifestyle counseling, such as education about the Stages of Change model 

and discussing goal setting with women, was reserved for lifestyle counselors. 

At the Cumberland County health department in Fayetteville, North Carolina, the 

lifestyle coordinator was the primary staff member trained to deliver the lifestyle 

intervention. An outreach worker and nurse supervisor were trained in WISEWOMAN 

procedures and provided program support through other means, including outreach, 

follow-up visits, and administrative duties. 

Staff Level of 

Effort: 

Project. Staff will spend time providing training on procedures to all 

WISEWOMAN staff and additional time providing specific training 

on the intervention to targeted staff. 

Local. Providing procedures training to all local WISEWOMAN staff 

will require an initial time investment. 

Other 

Considerations: 

If all local WISEWOMAN staff are trained on procedures, the project 

might need to produce extra materials or conduct additional visits to 

the site.

Staff Skill 

Level and 

Training: 

If all local staff members working on WISEWOMAN have not been 

trained in procedures, they will need this additional training. 

Things to 

Consider

Cultural 

Adaptability: 

N/A 

Contact 

Information

Michigan WISEWOMAN Project 

Phone: 517-335-1178 

North Carolina WISEWOMAN Project 

Phone: 919-707-5301 
Chapter IV: Adoption 74

TRAINING LOCAL SITE STAFF TO DELIVER WISEWOMAN

Practice(s) 9. Offer staff regular training opportunities to staff (Project) 

9A. Promote training on nutrition, physical activity, smoking cessation, goal setting, and 

other areas relevant to behavior change (Project) 

Description Regular staff training on lifestyle intervention procedures plays a key role in maintaining 

high-quality service delivery by ensuring that all staff conducting WISEWOMAN 

activities have current knowledge. Training opportunities might include yearly meetings 

or conferences, visits to local sites to train new staff, and ongoing updates regarding 

program service delivery. Projects can encourage local staff to attend training sessions 

that are related to the content of the lifestyle intervention. The project could host a 

training session or inform local sites of training that is hosted by a different organization. 

Examples 

from the 

Field 

Regular opportunities for staff training were part of the Every Woman Matters program 

in Nebraska. Class educators attended either a group statewide training once or twice a 

year and participated in distance training through telephone conference calls. At group 

trainings educators received content-related education, were provided with CDs 

containing lesson materials, and discussed content with the trainers. The trainers made 

suggestions for hands-on activities. The educators also requested and received training 

on supplemental lessons that addressed topics of interest to women, such as meal 

planning and dairy product consumption. 

Staff Level of 

Effort: 

Regular training programs might require considerable staff time for 

organization and planning, meeting attendance, and travel. Project 

staff might spend a limited amount of time informing local sites of 

special training opportunities. 

Other 

Considerations: 

Projects that conduct regular training programs can sponsor speakers 

and arrange venues and travel. If a project organizes additional 

specialized training, local staff travel and registration fees should be 

considered. 

Staff Skill 

Level and 

Training: 

To host regular training programs, project staff will need 

organizational and planning skills. They might also need to manage 

meeting activities as facilitators or presenters. The range of required 

knowledge pertaining to content of the training, either general or 

specialized, depends on whether the project staff are providing 

presentations or arranging for outside presenters. 

Things to 

Consider

Cultural 

Adaptability: 

Staff should ensure that training materials are culturally appropriate to 

meet local needs. 

Related 

Practices 

Chapter III, Effectiveness, Practice #5A 

Chapter V, Implementation, Practice #5 

Contact 

Information

Every Woman Matters, Nebraska WISEWOMAN Project 

Phone: 1-800-532-2227 
PROMOTING COMMUNICATION

Practice(s) 10. Promote regular communication between project staff and staff at local sites 

(Project) 

10A. Establish systems for two-way communication initiated by either the project or 

local sites (Project) 

10B. Provide ongoing forums for communication among local sites (Project) 

Description Communication between project and local staff can be in the form of e-mail, telephone 

calls, site visits, or newsletters. Regular communication helps ensure that project and 

local sites are aware of program issues and changes. Communication is beneficial when 

it occurs on a regular basis and is initiated by both projects and local sites. The project is 

better able to manage requests, answer questions, and assist with challenges. Local sites 

can inform the project of changes and seek advice when needed, and local sites can learn 

from each other through meetings and teleconferences. The project can support local 

site communication by providing a group setting to share information. 

The WISEWOMAN program in North Carolina promoted communication in a variety 

of ways. Project staff remained accessible by e-mail and telephone for ongoing 

communication. The project also distributed WISEWOMAN-specific information in 

the BCCEDP newsletter, Monthly Matters, as well as quarterly data tips for local sites. In 

addition, project staff visited local sites once a year for monitoring and technical 

assistance. 

Examples 

from the 

Field 

At the SEARHC WISEWOMAN program, the project director convened monthly 

videoconferences to encourage local sites to share lessons learned and to build general 

awareness of what other sites were doing. In addition to facilitating this sharing across 

local sites, the project director took advantage of monthly conferences to discuss new 

ideas and respond to questions; this fostered relationships among local staff and between 

project and local staff. 

 A sample issue of Monthly Matters is included in the appendix on page A.19. 

Some staff time will be spent establishing communication systems (for 

example, listservs) and returning telephone calls and e-mails in a timely 

manner. Ongoing time to engage in communication is required. 

Staff Level of 

Effort: 

Common modes of communication (telephone, conference calls, 

videoconference, travel for in-person meetings, and electronic and mail 

communication) require a range of infrastructure and resources. 

Other 

Considerations: 

Staff Skill 

Level and 

Training: 

Basic administrative skills are required for establishing e-mail and 

telephone contact systems and distributing media. 

Things to 

Consider

Cultural 

Adaptability: 

N/A 

Contact 

Information

North Carolina WISEWOMAN Project 

Phone: 919-707-5301 

SEARHC WISEWOMAN Project 

Phone: 907-966-8710 (ask for 

WISEWOMAN Project Director) 

Chapter IV: Adoption 75
Chapter IV: Adoption 76

PROMOTING COMMUNICATION

Practice(s) 11. Engage in brainstorming and strategizing discussions with local sites (Project) 

12. Proactively address local site barriers to delivering WISEWOMAN services (Project) 

Description Projects can brainstorm with local staff to address challenges and methods to improve 

performance. Projects facilitate discussions by (1) maintaining open communication and 

(2) being accessible to local sites by telephone and e-mail. By providing support to local 

sites, projects can reduce frustration experienced by local staff, increase local staff 

investment in program services, and foster communication between project and local 

staff. 

Proactive projects maintain communication with sites to stay aware of local issues and 

offer solutions. Project staff who actively make recommendations to local site staff have 

the potential to reduce or prevent local site barriers. 

Examples 

from the 

Field 

The lifestyle intervention coordinator in Nebraska’s Every Woman Matters program 

provided ongoing technical assistance to local sites that experienced barriers to women’s 

attendance at a four-session educational class. She provided encouragement and 

suggested site-specific ways to reduce barriers to class attendance, such as arranging 

classes at convenient times and encouraging outreach workers to develop close 

relationships with the women. The lifestyle intervention coordinator also made general 

recommendations to prevent potential barriers to class attendance. She encouraged local 

staff to coordinate with each other on an ongoing basis. For example, the outreach staff 

and the educators were instructed to plan several months in advance when scheduling 

classes to provide sufficient time to recruit women. To make the recruitment process 

more effective, the lifestyle intervention coordinator advised the outreach staff to attend 

the educators’ classes so that outreach staff have firsthand knowledge of the class when 

they describe it to women. 

Staff Level of 

Effort: 

Significant time might be spent brainstorming and strategizing with 

local sites. The amount of time that the project spends making 

recommendations and overseeing local sites will depend on what the 

project suggests and the local site’s level of interest in and ability to 

adopt the recommendation. 

Other 

Considerations: 

The project can choose from a variety of communication modes, such 

as telephone, conference calls, videoconference, or travel to the site. 

Staff Skill 

Level and 

Training: 

Communication and listening skills are valuable for brainstorming 

discussions. To enhance the project staff’s understanding of what will 

help local sites, sharp observational skills along with good listening 

skills are important. Project staff will need training on the local site 

operations to provide feasible recommendations. 

Things to 

Consider

Cultural 

Adaptability: 

N/A 

Contact 

Information

Every Woman Matters, Nebraska WISEWOMAN Project 

Phone: 1-800-532-2227 
Chapter IV: Adoption 77

PROMOTING COMMUNICATION

Practice(s) 13. Increase communication among local site staff within local sites and across local sites 

within a project (Local) 

Description Communication among local site staff members usually involves conversations about 

programmatic issues. A strategy used by high-performing sites to increase 

communication was to promote a team approach among staff assigned to 

WISEWOMAN. Staff meetings can help promote the team approach through regular 

communication with other staff members. Meetings are most helpful when they deal 

specifically with WISEWOMAN-related programmatic issues and purposefully engage 

staff in discussion. 

Examples 

from the 

Field 

WISEWOMAN staff at the Public Health Delta and Menominee Counties program in 

Escanaba, Michigan, sought to build a team approach for lifestyle counselors in the 

program. A team of lifestyle counselors contributed various areas of expertise (dietetics, 

health education, and nursing), and they informally learned from each other by sharing 

recommendations based on their backgrounds and expertise. In addition, lifestyle 

counselors attended internal quarterly meetings at which staff discussed ways to counsel 

women who resisted behavior change and successful counseling approaches that have 

led to improved screening rates among participating women. 

Staff Level of 

Effort: 

Staff interaction and networking on a regular basis requires time. 

Meetings are time consuming to plan and attend but the time required 

for planning and attendance will depend on the frequency and length 

of the meetings. 

Other 

Considerations: 

Local sites can choose from a variety of communication modes, such 

as telephone, conference calls, videoconference, or travel to the site. 

Staff Skill 

Level and 

Training: 

Staff will benefit from strong communication skills to promote and 

engage in dialogue with other staff members. No specific training is 

needed to increase communication among local staff; however, a site 

might identify a need for training on communication in the workplace. 

Things to 

Consider

Cultural 

Adaptability: 

N/A 

Contact 

Information

Michigan WISEWOMAN Project 

Phone: 517-335-1178 
ACTION CHECKLIST: 

ADOPTION – Engaging and Retaining WISEWOMAN Sites 

Is the Project or Site 

Interested in Adopting 

this Strategy? 

PROMOTING SITE AND STAFF BUY-IN

1. Provide clear expectations to local sites of program and service-delivery 

process 

2. Promote and foster buy-in among staff at local sites 

2A. Engage local sites in program planning 

2B. Emphasize to local staff the importance of adapting the lifestyle 

intervention to meet the needs of women 

3. Ensure that local sites are able to complete the paperwork used for 

reporting 

4. Develop an initial plan for implementation but revise this plan as needed 

5. Develop staff protocols to maximize percentage of time and resources that 

staff spend on WISEWOMAN duties 

SELECTING AND ARRANGING STAFF

6. Encourage high levels of commitment among staff working in 

WISEWOMAN programs 

6A. Maximize percentage of work time allocated to WISEWOMAN duties 

(versus duties for other programs) 

7. Identify staff members who are an appropriate fit for WISEWOMAN 

7A. Hire staff with educational backgrounds that match service delivery 

arrangement 

7B. Hire staff members who can speak the appropriate language to work with 

the population of women served 

7C. Recognize the importance of appropriate interpersonal skills in staff as 

well as training, previous experience, and educational background 

7D. Match interests of staff to their roles in WISEWOMAN 

TRAINING LOCAL SITE STAFF TO DELIVER WISEWOMAN

8. Train multiple staff in the procedures for WISEWOMAN but limit the 

number of staff trained to deliver the lifestyle intervention 

9. Offer staff regular training opportunities 

9A. Promote training on nutrition, physical activity, smoking cessation, goal 

setting, and other areas relevant to behavior change 

Chapter IV: Adoption 78
Chapter IV: Adoption 79

Is the Project or Site 

Interested in Adopting 

this Strategy? 

PROMOTING COMMUNICATION

10. Promote regular communication between project staff and staff at local 

sites 

10A. Establish systems for two-way communication initiated by either the 

project or local sites 

10B. Provide ongoing forums for communication among local sites 

11. Engage in brainstorming and strategizing discussions with local sites 

12. Proactively address local site barriers to delivering WISEWOMAN 

services 

13. Increase communication among local site staff within local sites and 

across local sites within a project 
Chapter IV: Adoption 80

THIS PAGE LEFT BLANK INTENTIONALLY FOR DOUBLE SIDED PRINTING
Chapter V: IMPLEMENTATION—

Delivering the Lifestyle 

Intervention 

WHAT IS IMPLEMENTATION? 

In the RE-AIM framework, the dimension of 

IMPLEMENTATION focuses on the consistent delivery of 

the lifestyle intervention according to its CDC-approved 

protocol. Ideally, IMPLEMENTATION guidelines make the 

intervention more feasible to deliver by providing 

recommendations on how to train staff, build community 

partnerships, and retain women in the intervention and 

program. 

WHAT TYPES OF PRACTICES ARE INCLUDED IN 

IMPLEMENTATION? 

Instituting strategies that support successful delivery of 

the lifestyle intervention is one of the keys to program 

success. Projects and local sites contribute to the 

intervention’s feasibility by resolving barriers that impede 

delivery. To ensure that the intervention is delivered as 

intended, the local site is often responsible for selecting 

staff with appropriate backgrounds to provide services. 

Projects play a key role in providing initial and ongoing 

training to local staff. Both projects and local sites can 

coordinate opportunities to expand staff knowledge 

through supplementary training. Partnerships with state 

and community organizations can assist local sites by 

augmenting their available resources as well as providing 

active referral sources. Developing systems for tracking 

women assists sites in retaining women in the program. 

 

IN THIS CHAPTER

3⁄4 Snapshots of implementation 

strategies from selected projects 82 

3⁄4 Details of implementation 

strategies from selected projects 83 

3⁄4 Action checklist with strategies for 

delivering lifestyle interventions 93

Chapter V: Implementation 81
Chapter V: Implementation 82

SNAPSHOTS OF IMPLEMENTATION PRACTICES FROM SELECTED PROJECTS

ProjectLevel 

Practice 

LocalLevel 

Practice 

Page 

Described 

Tool 

Included 

on Page 

INTERVENTION FEASIBILITY

1. Assess local site barriers to delivering the lifestyle 

intervention and make mid-course corrections 9 83 

2. Engage in a process of adapting the lifestyle 

intervention that involves both project and local site 

staff 

9 83 

3. Identify the purpose of assessments used in the 

lifestyle intervention and ensure that assessments are 

feasible for women and local sites to complete 

9 85 A.22 

LIFESTYLE INTERVENTION TRAINING

4. Hire staff with specialized training that is 

appropriate for their roles in WISEWOMAN 9 86 

5. Train and retrain staff to deliver the lifestyle 

intervention 9 9 87 

6. Reinforce project-provided training on 

WISEWOMAN and the lifestyle intervention on a 

regular basis 

9 87 

PARTNERING

7. Partner with organizations that employ staff with the 

necessary skills and expertise to deliver the lifestyle 

intervention 

9 89 

8. Partner with community organizations and health 

care providers 

9 90 

8A. Develop a proactive referral system to facilitate 

delivery of care 

9 90 

RETAINING WOMEN

9. Develop a tracking system to identify women in 

need of re-screening 9 92 
Chapter V: Implementation 83

DETAILS OF IMPLEMENTATION STRATEGIES FROM SELECTED PROJECTS

INTERVENTION FEASIBILITY

Practice(s) 1. Assess local site barriers to delivering the lifestyle intervention and make mid-course 

corrections (Project) 

2. Engage in a process of adapting the lifestyle intervention that involves both project and 

local site staff (Project) 

Description Local sites might experience barriers that impede their ability to deliver the intervention as 

designed. For example, projects might provide materials to local sites that are 

cumbersome to use or do not reflect the culture or literacy level of women, or the 

intervention might require that services be delivered through a mode of contact that is 

challenging for women, such as in-person contacts. Through active communication 

between projects and local sites, projects can assess where barriers exist and make 

modifications to the intervention to target these barriers. In addition, projects can engage 

staff from local sites in the adaptation process to ensure that changes will be feasible in 

their communities. 

Examples 

from the 

Field 

The Michigan WISEWOMAN project solicited regular feedback from local sites by 

telephone, e-mail, and in-person contact on the delivery of the lifestyle intervention to 

identify and address barriers to delivery. Through this communication, the project 

identified a concern that women expressed related to one of the forms used during the 

intervention. Originally, women initiating the lifestyle intervention developed lifestyle 

goals to pursue throughout the year, and these were documented on a “Lifestyle 

Contract” form. The word “contract” dissuaded some women from committing to 

developing goals, discouraging program participation. To address the aversion to this 

word, the project renamed the form “Healthy Lifestyle Goals.” 

Another example is from the Women’s Health Network in Massachusetts, which used 

PACE (see Appendix B for a description of PACE) as its lifestyle intervention. 

Originally, materials for PACE were available in Spanish as well as English. After sites 

began to use the materials, the project identified concerns with the cultural 

appropriateness and literacy level of the materials. To address these concerns, the project 

engaged in a long-term effort to adapt PACE to address both the cultural and literacy 

needs of the women served. First, Massachusetts developed a low-literacy version of 

PACE in English, which then served as the foundation for Spanish, Portuguese, and 

Chinese cultural and linguistic adaptations. As part of the adaptation process, the project 

convened focus groups with community members to understand physical activity and 

food preferences. After the adaptations were developed, the materials were pilot tested by 

Women’s Health Network participants and assessed for usability by staff. 

Things to 

Consider 

Staff Level of 

Effort: 

Staff might spend time overcoming local barriers and brainstorming 

about feasible changes to the intervention’s characteristics, (such as 

altering the mode of delivery) while maintaining the intervention’s core 

elements. Staff might also spend time drafting and sharing revised 

procedures or translating materials. 
Chapter V: Implementation 84

Other 

Considerations: 

Projects might communicate by telephone and travel to local sites and 

might provide revised forms or notices of procedure changes as 

necessary. Depending on the revision process, approval by an 

institutional review board might be necessary if the process includes 

focus groups or other activities with women. 

Staff Skill 

Level and 

Training: 

Staff should possess good communication and listening skills and have a 

working knowledge of the lifestyle intervention, including it’s core 

elements, characteristics, and intended delivery. Understanding the 

CDC evaluation framework is useful as well. 

Cultural 

Adaptability: 

Ways to address barriers to the lifestyle intervention delivery might 

include changes that result in a more culturally appropriate approach for 

the priority population. 

Related 

Practices 

Chapter IV, Adoption, Practice #2B 

Contact 

Information 

Michigan WISEWOMAN Project 

Phone: 517-335-1178 

Women’s Health Network, Massachusetts WISEWOMAN Project 

Phone: 617-624-5434 
INTERVENTION FEASIBILITY

3. Identify the purpose of assessments used in the lifestyle intervention and ensure that 

assessments are feasible for women and local sites to complete (Project) 

Practice(s) 

Projects use assessments for program evaluation and to provide feedback to participants. 

Assessments are often conducted to gather information related to women’s clinical 

screening results or health behaviors. If used consistently over time, they can provide a 

long-term perspective on the changes women make. Although assessments serve an 

important role in providing feedback about participants to the project, local site, or 

women, it is critical not to overburden participants or staff at local sites with cumbersome 

and complicated assessment forms. By soliciting input from local sites on the selection of 

assessment forms, projects can ensure feasibility while continuing to gather needed 

information for program evaluation and participant feedback. In addition, when revising 

assessment forms, projects can ensure maintenance of the intervention’s core elements. 

Description 

The Michigan WISEWOMAN project developed a Healthy Lifestyle Assessment form to 

provide feedback to sites regarding women’s behaviors. The form has a clearly articulated 

purpose, is brief, and targeted. It includes eight short and simple questions about current 

eating and physical activity patterns as well as five statements to help identify a woman’s 

readiness to change her behavior. The assessment form was designed to be completed at 

the initial intervention contact, and staff used the form as a reference point for 

individualizing their discussions about a woman’s nutrition, physical activity, and tobacco 

cessation goals. The assessment offered interventionists a tool to help women understand 

their behaviors and how those behaviors are connected to cardiovascular disease risk 

factors. 

Examples 

from the 

Field 

 The Healthy Lifestyle Assessment is included as a tool in the appendix on page 

A.22. 

Staff Level of 

Effort: 

The process of checking that assessments have a stated purpose, 

communicating with sites regarding their feasibility, and making 

subsequent revisions will involve staff time. 

Other 

Considerations: 

The project might need to print and distribute new assessment 

materials. 

Staff Skill 

Level and 

Training: 

Staff should possess communication skills and understand the purpose 

of the assessment in the context of the intervention. In addition, if 

assessments will be used for evaluation, staff should be familiar with 

program evaluation techniques. 

Things to 

Consider 

Cultural 

Adaptability: 

Assessments can be made culturally appropriate by including relevant 

examples of foods eaten and types of preferred activities. 

Contact 

Information 

Michigan WISEWOMAN Project 

Phone: 517-335-1178 

Chapter V: Implementation 85
Chapter V: Implementation 86

LIFESTYLE INTERVENTION TRAINING

Practice(s) 4. Hire staff with specialized training that is appropriate for their roles in WISEWOMAN 

(Local) 

Description Consistent with the variations in the lifestyle interventions used by WISEWOMAN 

programs in different locales, the training and background of staff who deliver the 

interventions vary greatly. It is important that local sites hire staff with training and 

backgrounds that are appropriate for the lifestyle intervention they have selected and for 

the settings in which the intervention will be delivered. For example, lifestyle 

interventionists who counsel women in a clinical setting might benefit from training on 

cardiovascular disease case management, physical activity, nutrition, and tobacco cessation 

treatment. Other counselors might benefit from specialized training in health education 

and promotion, nursing, adult learning theory, or motivational interviewing techniques. 

For staff who have teaching roles, a background in education is useful. 

The CDC’s guidance document, The Heart of the Matter,8 provides descriptions of the types 

of activities in which health educators engage when delivering lifestyle interventions. 

Local sites might refer to this list when considering appropriate staff. 

Examples 

from the 

Field 

The WISEWOMAN coordinator in Fayetteville, North Carolina, provided screening 

services, conducted outreach, delivered the lifestyle intervention, and coordinated patient 

flow and service delivery. Her background as a registered nurse enabled her to fulfill 

many of these duties. She remained up to date on information relevant to the 

intervention by attending additional training programs, such as annual project meetings 

and external training sessions that address cardiovascular disease, tobacco cessation 

treatment, case management, counseling techniques, and goal setting. 

Staff Level of 

Effort: 

The site might spend additional time selecting a staff member with the 

appropriate specialized skills for his or her role. Site staff can develop 

job descriptions to help identify appropriately trained people. 

Other 

Considerations: 

Selecting staff with appropriate skills and facilitating their training might 

require hiring higher salaried professionals or paying training 

registration fees. 

Staff Skill 

Level and 

Training: 

Supervisory staff at the local site will benefit from a clear understanding 

of the specific skills and training needed for each staff role. 

Things to 

Consider 

Cultural 

Adaptability: 

During the hiring process, staff might seek a candidate with specific 

skills, such as people who speak the language or understand the cultural 

practices of the priority population(s). 

Related 

Practices 

Chapter II, Reach, Practice #12 

Chapter IV, Adoption, Practice #6 

Contact 

Information 

North Carolina WISEWOMAN Project

Phone: 919-707-5301 

 8 The guidance document is available at http://www.cdc.gov/wisewoman/. 
Chapter V: Implementation 87

LIFESTYLE INTERVENTION TRAINING

Practice(s) 5. Train and retrain staff to deliver the lifestyle intervention (Project, Local) 

6. Reinforce project-provided training on WISEWOMAN and the lifestyle intervention on 

a regular basis (Local) 

Description Training is an ongoing process from which staff benefit over time. High-performing sites 

recognized that, initially, staff required basic training on how to deliver the intervention as 

designed. Over time, training can focus on reviewing basic service delivery and teaching 

new skills that are relevant to the intervention. Training might be offered by the program 

or an external organization. Outside training might focus on innovative counseling 

strategies or deepen staff content knowledge of nutrition, physical activity, or tobacco 

cessation. 

Both projects and local sites have a role in training staff to deliver the intervention. At the 

beginning, projects must provide some foundational training to local staff. After a while, 

local sites might be able to conduct their own training that reinforces and expands upon 

project-provided training. Training sessions might be delivered in multiple ways and vary 

over time. For example, initial training might entail a site visit by project staff to the local 

site, while ongoing training might be accomplished at group meetings or by 

teleconference. 

Examples 

from the 

Field 

In the Nebraska Every Woman Matters program, the cooperative extension services 

coordinator trained extension educators to deliver a specific curriculum to 

WISEWOMAN participants. These training sessions have occurred through in-person 

group meetings and remote meetings using distance learning techniques (e.g., 

teleconference, videoconference). After providing initial training on the curriculum, 

educators shared strategies to deliver the material, which helped staff review the basic 

content as well as extend their knowledge. 

The SEARHC WISEWOMAN project actively encouraged local staff to attend training 

programs that will enhance their job performance, and the local staff enthusiastically take 

part in these training opportunities. For example, most local staff have attended the 

public health nutrition course offered by the University of North Carolina at Chapel Hill 

as well as training sessions on physical activity and tobacco cessation counseling. 

Staff Level of 

Effort: 

Staff might spend time attending or preparing for retraining meetings 

(organization, content preparation, and travel). 

Other 

Considerations: 

Projects might need to consider registration for training, renting 

facilities, travel, or supplying materials. 

Staff Skill 

Level and 

Training: 

Staff should have strong communication and organizational skills. In 

addition, staff who conduct training must possess deep content 

knowledge of training topics and strong presentation skills. 

Things to 

Consider 

Cultural 

Adaptability: 

Training might target specific cultural needs of a local community, 

which can change over time. 

Related 

Practices 

Chapter III, Effectiveness, Practice #5A 

Chapter IV, Adoption, Practice #9 
Chapter V: Implementation 88

Contact 

Information 

Every Woman Matters, Nebraska 

WISEWOMAN Project 

Phone: 1-800-532-2227 

SEARHC WISEWOMAN Project 

Phone: 907-966-8710 (ask for 

WISEWOMAN Project Director) 
Chapter V: Implementation 89

PARTNERING

Practice(s) 7. Partner with organizations that employ staff with the necessary skills and expertise to 

deliver the lifestyle intervention (Project) 

Description In some areas, identifying appropriately trained staff to deliver the lifestyle intervention is 

a challenge. By developing partnerships with organizations that have staff with the 

needed skills, projects can proactively cultivate this existing resource and use the partner’s 

staff to deliver lifestyle intervention services. This approach might offer a cost-effective 

solution to projects by providing them with appropriately trained staff in a capacity 

determined by the project and partner organization, without assuming the cost of hiring 

these staff for full- or part-time work. 

Examples 

from the 

Field 

The Nebraska Every Woman Matters program offered women the opportunity to 

participate in a class-format lifestyle intervention. To ensure that trained staff were 

available to deliver the classes, the Nebraska program partnered with the state cooperative 

extension services at the University of Nebraska. The cooperative extension services had 

educators located throughout the state at county extension offices. For Every Woman 

Matters, educators offered ABC classes in 70 of 93 counties in Nebraska (see Appendix B 

for a description of ABC classes). The Every Woman Matters program used these local 

educators to deliver the WISEWOMAN intervention classes. The educators had master’s 

level training in such areas as education, home economics, and dietetics, which made 

them well suited to deliver the intervention. 

Staff Level of 

Effort: 

Investigating opportunities within the community and negotiating the 

terms of the partnerships will take time. Projects might identify a staff 

person to serve as a liaison with the partner organization. This staff 

person will devote a significant amount of time working with the 

partner organization. 

Other 

Considerations: 

In establishing a partnership, the project might host meetings or travel 

to visit prospective partners. 

Staff Skill 

Level and 

Training: 

Staff should be aware of the needed content knowledge and duties of 

workers in the partner organization. 

Things to 

Consider 

Cultural 

Adaptability: 

The site might seek partners whose staff have the skills and experience 

required to meet the needs of the cultural groups served by 

WISEWOMAN. 

Related 

Practices 

Chapter II, Reach, Practice #7 

Chapter II, Reach, Practice #8 

Chapter II, Reach, Practice #9 

Chapter V, Implementation, Practice #8 

Chapter VI, Maintenance, Practice #16A/B

Contact 

Information 

Every Woman Matters, Nebraska WISEWOMAN Project 

Phone: 1-800-532-2227 
Chapter V: Implementation 90

PARTNERING

Practice(s) 8. Partner with community organizations and health care providers (Local) 

8A. Develop a proactive referral system to facilitate delivery of care (Local) 

Description Partnering with community organizations (e.g., fitness centers, support groups) and health 

care providers (e.g., free or reduced-fee clinics) enables sites to provide supplemental 

services that help women make behavior changes and receive the follow-up medical care 

they need. High-performing sites engaged in multiple, varied, and meaningful 

partnerships to offer women a range of opportunities. These strategies can increase the 

extent to which women utilize these services. 

Sites that proactively assist women in using resources and services offered by partners, as 

opposed to using more passive strategies like making women aware of local resources, are 

more likely to succeed in encouraging women to take advantage of services offered by 

partners. Proactive strategies might include facilitating the use of resources that address a 

targeted concern, such as access to needed medical prescriptions, and assisting the woman 

in contacting the resource. High-performing sites focused on simplifying the referral 

process to ensure that women receive needed services.

Examples 

from the 

Field 

In Plymouth, Massachusetts, the WISEWOMAN program had multiple partnerships with 

providers and community organizations. Women were informed about opportunities to 

attend partnership activities during telephone contacts with program staff. Within the site 

hospital, the program partnered with a hospital-run diabetes education program. Within 

the community, the site contracted with an independent tobacco cessation treatment 

specialist who conducted individualized and group smoking cessation counseling sessions. 

Also, the site arranged access for women to free sessions for 3 weeks at a local health club 

with a personal trainer who designs at-home fitness programs. Recognizing the potential 

financial barrier to continuing the gym membership, the site alerted the health club that 

women were unlikely to continue their membership beyond 3 weeks. The at-home fitness 

program encouraged women to continue the behavior change initiated during the trial 

gym membership. 

In Fayetteville, North Carolina, staff actively referred women to community resources, 

including the local prescription assistance program. To encourage women to take 

advantage of this resource, staff inquired about needed medications during the 

intervention session and assisted women in completing paperwork. Staff also delivered 

the paperwork to the prescription assistance program and ensured that the women 

received the medications. 

Staff Level of 

Effort: 

Investigating referral services available in the community, educating 

providers and organizations about WISEWOMAN, and establishing the 

partnerships and referral services will take time. 

Other 

Considerations: 

Additional considerations are not anticipated. 

Things to 

Consider 

Staff Skill 

Level and 

Training: 

Staff should have a working knowledge of the program objectives and 

procedures to adequately inform potential partners about the program. 

Staff working with providers and community organizations should have 

good communication skills. 
Chapter V: Implementation 91

Cultural 

Adaptability: 

Services offered by partners can be specifically targeted to cultural 

groups served by WISEWOMAN programs. 

Related 

Practices 

Chapter II, Reach, Practice #7 

Chapter II, Reach, Practice #8 

Chapter II, Reach, Practice #9 

Chapter V, Implementation, Practice #7 

Chapter VI, Maintenance, Practice #16A/B 

Contact 

Information 

Women’s Health Network, Massachusetts WISEWOMAN Project 

Phone: 617-624-5434 

North Carolina WISEWOMAN Project 

Phone: 919-707-5301 
Chapter V: Implementation 92

RETAINING WOMEN

Practice(s) 9. Develop a tracking system to identify women in need of re-screening (Local) 

Description Local sites monitor when women need to complete their re-screening visits in a variety of 

ways. High-performing sites developed tracking and reminder systems to remind staff to 

contact women directly about the need for an appointment. These systems included a 

method to alert staff about women eligible for re-screening in the upcoming month, a 

computer database to notify staff about women needing a reminder call that month, and a 

database system that generated reminder letters for women. In addition, high-performing 

sites developed tracking systems to alert providers about women requiring re-screening, 

which enabled the provider to conduct this re-screening during the women’s next visit to 

the clinic. 

Examples 

from the 

Field 

Local sites in the SEARHC project used different types of systems to identify women in 

need of re-screening. In Haines, Alaska, the WISEWOMAN program used a computer 

database system that generated letters addressed to women 1 month before their rescreening appointment was due. In Juneau, Alaska, the WISEWOMAN program placed a 

form in the woman’s medical chart to notify clinic providers that the woman was due for 

a WISEWOMAN re-screening. Clinic providers were trained to complete this screening 

with the woman when she came for her clinic appointment, thus reducing the number of 

visits she had to make to the clinic for services. 

Staff Level of 

Effort: 

The time spent on developing and maintaining the tracking system will 

vary according to its sophistication. The time needed to make 

telephone calls, send letters, or contact providers with alert forms will 

depend on the site’s caseload. 

Other 

Considerations: 

Additional considerations are not anticipated. 

Staff Skill 

Level and 

Training: 

Staff members who develop and maintain a tracking system should have 

strong computer and organizational skills. Staff who contact women 

should have good interpersonal skills. 

Things to 

Consider 

Cultural 

Adaptability: 

Local sites might need to consider specific cultural preferences when 

using tracking and reminder systems. 

Contact 

Information 

SEARHC WISEWOMAN Project 

Phone: 907-966-8710 (ask for WISEWOMAN Project Director) 
ACTION CHECKLIST: 

IMPLEMENTATION—Delivering the Lifestyle Intervention 

Is the Project or Site 

Interested in Adopting 

this Strategy? 

INTERVENTION FEASIBILITY

1. Assess local site barriers to delivering the lifestyle intervention and make midcourse corrections 

2. Engage in a process of adapting the lifestyle intervention that involves both 

project and local site staff 

3. Identify the purpose of assessments used in the lifestyle intervention and 

ensure that assessments are feasible for women and local sites to complete 

LIFESTYLE INTERVENTION TRAINING

4. Hire staff with specialized training that is appropriate for their roles in 

WISEWOMAN 

5. Train and retrain staff to deliver the lifestyle intervention 

6. Reinforce project-provided training on WISEWOMAN and the lifestyle 

intervention on a regular basis 

PARTNERING

7. Partner with organizations that employ staff with the necessary skills and 

expertise to deliver the lifestyle intervention 

8. Partner with community organizations and health care providers 

8A. Develop a proactive referral system to facilitate delivery of care 

RETAINING WOMEN

9. Develop a tracking system to identify women in need of re-screening 

Chapter V: Implementation 93
Chapter V: Implementation 94

THIS PAGE LEFT BLANK INTENTIONALLY FOR DOUBLE SIDED PRINTING
Chapter VI: MAINTENANCE—

Sustaining WISEWOMAN 

WHAT IS MAINTENANCE? 

At the individual level, the dimension of 

MAINTENANCE in the RE-AIM framework focuses on 

sustaining program participation through re-screening and 

sustaining positive behavior and clinical changes. At the 

institutional level, MAINTENANCE refers to sustaining 

program operations. 

WHAT TYPES OF PRACTICES ARE INCLUDED IN 

MAINTENANCE? 

 As applied to WISEWOMAN, the practices within 

MAINTENANCE at the individual level focus on addressing 

long-term participation in the screening and lifestyle 

intervention as well as sustaining behavior changes that 

women make. At the institutional level, MAINTENANCE

focuses on sustaining the operation of WISEWOMAN at 

the state or tribal project level as well as at local sites. 

Projects and local sites encourage long-term participation 

by using innovative strategies to increase re-screening rates 

and long-term involvement in the intervention. Projects 

and local sites can facilitate the maintenance of behavior 

change and improvements in cardiovascular risk factors 

internally as well as refer women to external resources 

made available through community partnerships. By 

partnering with other programs and organizations, 

programs can position themselves for long-term 

sustainability. 

 

From a WISEWOMAN Participant 

"My eating habits will probably 

continue to improve because I’m 

getting used to the fruits and vegetables. 

I used to grab a Twinkie. Now I grab a 

banana. That’s what I pack in my lunch. 

It’s becoming just the way I am.”

IN THIS CHAPTER

3⁄4 Snapshots of maintenance strategies 

from selected projects 96 

3⁄4 Details of maintenance strategies 

from selected projects 98 

3⁄4 Action checklist with strategies for 

sustaining WISEWOMAN 116

Chapter VI: Maintenance 95
Chapter VI: Maintenance 96

SNAPSHOTS OF MAINTENANCE PRACTICES FROM SELECTED PROJECTS

ProjectLevel 

Practice 

LocalLevel 

Practice 

Page 

Described 

Tool 

Included 

on Page 

LONG-TERM PROGRAM PARTICIPATION

1. Develop strategies to increase re-screening rates in 

local sites 

9 9 98 

1A. Send multiple reminders to women about rescreening appointments 

9 9 98 

1B. Use multiple modes of contact to reach women for 

re-screening 

9 9 98 

2. Use incentives to encourage women to return for 

screening and intervention activities 9 9 99 

3. Develop practices that facilitate long-term 

participation in WISEWOMAN for interested women 

9 9 100 

4. Update contact information for women during each 

visit or contact 

9 9 101 

5. Institute a sense of belonging to the program through 

the use of membership cards that expire after 12 

months 

9 9 102 

6. Provide opportunities for WISEWOMAN 

involvement on an ongoing basis 

9 9 103 

7. Distribute newsletters to all enrolled women 9 9 104 

8. Expand program services to meet additional needs of 

women 

9 9 105 

LONG-TERM BEHAVIOR CHANGE

9. Create strategies that focus on maintaining behavior 

changes in women 

9 9 106 

10. Use incentives to promote maintenance of behavior 

changes 

9 9 107 

11. Link women to free or low-cost resources that 

support behavior change 

9 9 108 

12. Offer women opportunities for support from 

themselves and others 

9 9 108 

13. Conduct follow-up through telephone contact or email 

9 9 110 
Chapter VI: Maintenance 97

LocalLevel 

Practice 

Page 

Described 

Tool 

Included 

on Page 

ProjectLevel 

Practice 

14. Identify ways to maintain positive changes and 

further improve risk factors 

9 9 111 

14A. Offer positive reinforcements for changes in risk 

factors 

9 9 111 

14B. Compare screening results from one year to the 

next for a longer term perspective 

9 9 111 

15. Identify resources to provide women access to 

needed medications 

9 9 113 

LONG-TERM PROGRAM SUSTAINABILITY

16. Increase the long-term sustainability of the 

WISEWOMAN program 9 9 114 

16A. Integrate the WISEWOMAN program into other 

programs and into clinic or hospital services 9 9 114 

16B. Develop partnerships for program sustainability 9 9 114 
Chapter VI: Maintenance 98

DETAILS OF MAINTENANCE STRATEGIES FROM SELECTED PROJECTS

LONG-TERM PROGRAM PARTICIPATION

Practice(s) 1. Develop strategies to increase re-screening rates in local sites (Project, Local) 

1A. Send multiple reminders to women about re-screening appointments (Project, Local) 

1B. Use multiple modes of contact to reach women for re-screening (Project, Local) 

Description Long-term program participation relies on the site’s efforts to both recapture women at 

each re-screening appointment and recruit new women into the program. To facilitate 

the process of re-enrolling women, sites can employ several methods, such as reminding 

women multiple times using various methods and distributing incentives to encourage 

women to return. 

Reminding women multiple times of upcoming re-screening due dates increases the 

likelihood that women will return. Staff can offer verbal encouragement during in-person 

visits and telephone conversations and can send written reminders by mail or e-mail. At 

the annual screening appointment, sites can also distribute membership cards that expire 

after 1 year to encourage women to return to receive a new card. In addition, staff can 

work with other on-site providers, such as clinical staff, to encourage women to return for 

re-screening. The use of more than one mode of contact to remind women about rescreening helps promote long-term participation. 

Examples 

from the 

Field 

In Nebraska, the Every Woman Matters program provided local sites with a monthly 

report listing women who required re-screening appointments. Local sites sent 

standardized letters to remind women that they were due for re-screening. In addition, 

outreach workers at local sites contacted women by telephone to encourage them to 

return for re-screening. 

Staff Level of 

Effort: 

Contacting women takes time, especially when follow-up is needed with 

women who do not respond to initial contact efforts or whose contact 

information has changed. 

Other 

Considerations: 

The use of reminders can entail producing and mailing letters, 

membership cards, or other incentives that target re-enrollment. 

Staff Skill 

Level and 

Training: 

Staff should possess organizational skills to track women for rescreening and strong interpersonal skills to encourage women to attend 

re-screening appointments. 

Things to 

Consider 

Cultural 

Adaptability: 

The language and examples used in written reminders can be adapted to 

the culture and literacy level of program participants. Staff members 

who call participants to remind them of re-screening should speak the 

appropriate language and adapt their messages so that they are culturally 

appropriate. In addition, sites can choose a method of contact that is 

suitable for contacting targeted women (for example, use telephone calls 

instead of letters for women with low literacy levels). 

Related 

Practices 

Chapter III, Effectiveness, Practice #8 

Chapter III, Effectiveness, Practice #13 

Contact 

Information 

Every Woman Matters, Nebraska WISEWOMAN Project 

Phone: 1-800-532-2227 
Chapter VI: Maintenance 99

LONG-TERM PROGRAM PARTICIPATION

Practice(s) 2. Use incentives to encourage women to return for screening and intervention activities 

(Project, Local) 

Description Projects and local sites offer a variety of incentives that encourage women to return for 

screening and intervention activities. High-performing local sites offered women direct 

reminders, such as telephone calls and letters, as well as indirect reminders, such as 

membership cards that expire after 12 months. Other strategies involve enlisting clinic 

providers working for other programs to remind women about the program. These 

incentives reduce participation barriers, commemorate length of program participation, and 

enhance women’s enjoyment of the program. Incentives to encourage women to return can 

include a token piece of jewelry to mark each year spent in the program, gas cards to reduce 

the cost of transportation to the program, or tote bags and water bottles for women to use for 

WISEWOMAN activities. 

A WISEWOMAN participant described the importance of incentives: “It was so cool because I’d 

never had [a pedometer] before! And the pen! We do matter! It makes you think, ‘I’m important ..., I still 

count as a person. Somebody out there cares about me.’”

Examples 

from the 

Field 

The Michigan WISEWOMAN program provided local sites with a variety of incentives to 

encourage ongoing participation. Local staff informed women of the incentives to be 

distributed at upcoming sessions with the intent of motivating women to attend. For 

example, during a lifestyle intervention session, the interventionist would inform the woman 

that during her next visit she would receive a pedometer and they would discuss how to use it 

to encourage her to increase her level of physical activity. 

The SEARHC program in Alaska gave women a small piece of jewelry (a pin or necklace) at 

their initial screening appointment and each time they were re-screened thereafter. A Native 

artist developed the design for each year’s piece of jewelry, and women knew that if they 

continued to be screened, they would receive these incentives each year. 

Staff Level of 

Effort: 

Time might be spent selecting appropriate incentives as well as ordering, 

purchasing, and distributing them to sites. 

Other 

Considerations: 

The project or local site might be responsible for purchasing incentives, and 

projects might consider distributing incentives to sites. 

Staff Skill 

Level and 

Training: 

Understanding the community and the program is necessary to choose 

incentives that will encourage women to continue with the program. 

Specific skills or training are not required to distribute incentives. 

Things to 

Consider 

Cultural 

Adaptability: 

Incentives should be targeted toward women in a culturally appropriate 

manner, ensuring that they will be of value and not offensive to recipients. 

Related 

Practices 

Chapter II, Reach, Practice #6B 

Chapter III, Effectiveness, Practice #22 

Chapter VI, Maintenance, Practice #10 

Contact 

Information 

Michigan WISEWOMAN Project 

Phone: 517-335-1178 

SEARHC WISEWOMAN Project 

Phone: 907-966-8710 (ask for 

WISEWOMAN Project Director) 
Chapter VI: Maintenance 100

LONG-TERM PROGRAM PARTICIPATION

Practice(s) 3. Develop practices that facilitate long-term participation in WISEWOMAN for 

interested women (Project, Local) 

Description Facilitating long-term WISEWOMAN participation involves keeping current contact 

information for women and catering to their needs and interests as they participate in 

program activities. Sites can choose to use multiple strategies to make program 

participation appealing to women. The five strategies listed below, which are described in 

the tables, were identified as best practices to facilitate long-term participation: 

Update contact information for women during each visit or contact (Project, Local) 

Institute a sense of program belonging to the program through the use of 

membership cards that expire after 12 months (Project, Local) 

Provide opportunities for WISEWOMAN involvement on an ongoing basis (Project, 

Local) 

Distribute newsletters and mailings to all enrolled women (Project, Local) 

Expand program services to meet additional needs of women (Project, Local)

Examples 

from the 

Field 

Examples from the field of best practices that facilitate long-term participation are 

described in the tables for strategies 4–8. 

Things to 

Consider 

Things to consider for best practices that facilitate long-term participation are described 

the tables for strategies 4–8. 

Contact 

Information 

Contact information for programs with best practices that facilitate long-term 

participation is provided the tables for strategies 4–8. 
Chapter VI: Maintenance 101

LONG-TERM PROGRAM PARTICIPATION

Practice(s) 4. Update contact information for women during each visit or contact (Project, Local) 

Description In some locations, women’s mobility makes tracking them a challenge. To maintain 

records with women’s current contact information, the site can gather updated 

information on a regular basis. For WISEWOMAN programs that have frequent contact 

with women, updated information can be obtained during some rather than all contacts, 

whereas programs with infrequent contact might want to ask women for updated 

information at most or all contacts. 

Examples 

from the 

Field 

At the Every Woman Matters program in Kearney, Nebraska, outreach workers gathered 

updated contact information from participants during the last call in a series of 

intervention sessions. This increased the likelihood that outreach workers would connect 

with women to schedule the next re-screening appointment. 

Staff Level of 

Effort: 

Projects might spend a small amount of time encouraging local staff to 

obtain updated information on their participants. Little time is needed 

for local staff to gather updated information because this is done while 

they are providing regular program services to women. 

Other 

Considerations: 

Additional considerations are not anticipated. 

Staff Skill 

Level and 

Training: 

If regularly updating participant contact information is part of the 

project protocol, staff should be trained on doing this. 

Things to 

Consider 

Cultural 

Adaptability: 

N/A 

Contact 

Information 

Every Woman Matters, Nebraska WISEWOMAN Project 

Phone: 1-800-532-2227 
Chapter VI: Maintenance 102

LONG-TERM PROGRAM PARTICIPATION

Practice(s) 5. Institute a sense of belonging to the program through the use of membership cards that 

expire after 12 months (Project, Local) 

Description Membership cards offer women a sense of belonging to the program because they are a 

tangible reminder of the program. The cards can also be used to provide women access 

to free and reduced-cost activities associated with WISEWOMAN. When the cards 

expire, women are encouraged to re-enroll by participating in a re-screening visit to avoid 

forfeiting their access to certain program activities. 

Examples 

from the 

Field 

The SEARHC WISEWOMAN program encouraged local sites to use membership cards. 

In some sites, the membership card provided women access to program activities (e.g., 

free swimming pool use and discounts for other physical activity programs). In one site, 

some women who lacked a valid card scheduled a re-screening appointment to take 

advantage of these discounts. 

Staff Level of 

Effort: 

Staff might spend some time designing, developing, and distributing 

membership cards. Time might also be spent forming relationships 

with organizations that offer free or reduced-free services to card 

holders. 

Other 

Considerations: 

Printing or laminating cards is a consideration. 

Staff Skill 

Level and 

Training: 

No special skills are required to develop membership cards. 

Things to 

Consider 

Cultural 

Adaptability: 

Cards can be written in the language of the women served by the 

program. 

Contact 

Information 

SEARHC WISEWOMAN Project 

Phone: 907-966-8710 (ask for WISEWOMAN Project Director)
Chapter VI: Maintenance 103

LONG-TERM PROGRAM PARTICIPATION

Practice(s) 6. Provide opportunities for WISEWOMAN involvement on an ongoing basis (Project, 

Local) 

Description To encourage program participation, projects and sites can offer enrollees access to 

activities such as support groups, walking groups, fitness and stress-reduction sessions, 

tobacco cessation counseling, and other ongoing activities that are supplemental to the 

project’s lifestyle intervention. Because they are ongoing activities, they might increase 

the likelihood that women will remain engaged in the program. 

Examples 

from the 

Field 

The SEARHC WISEWOMAN program made educational and experiential activities 

available to women in addition to the standard lifestyle intervention provided during the 

annual screening visit. In Haines, Alaska, the health educator organized many types of 

activities that took place at least twice a month, including strength training classes twice a 

week, weekly swimming at the community pool, yoga classes, low-impact aerobics, 

gathering local fruits and vegetables, and community gardening during the summer. 

Staff Level of 

Effort: 

Staff might spend considerable time organizing and coordinating 

activities on an ongoing basis as well as brainstorming new ideas and 

testing participation. 

Other 

Considerations: 

Staff might arrange venues or provide food. 

Staff Skill 

Level and 

Training: 

Staff should possess strong organizational and networking skills as well 

as related content knowledge or training to provide activities. 

Things to 

Consider 

Cultural 

Adaptability: 

Activities can be adapted to meet the cultural preferences of 

participants. 

Contact 

Information 

SEARHC WISEWOMAN Project 

Phone: 907-966-8710 (ask for WISEWOMAN Project Director) 
Chapter VI: Maintenance 104

LONG-TERM PROGRAM PARTICIPATION

Practice(s) 7. Distribute newsletters to all enrolled women (Project, Local) 

Description Distributing newsletters is a strategy to maintain contact with women. High-performing 

local sites mailed newsletters on an ongoing basis to all women who had ever enrolled in 

WISEWOMAN, rather than limiting distribution to those current with their screening. 

Newsletters can keep women informed about upcoming program events and provide 

educational information on heart-healthy nutrition and physical activity. To increase their 

appeal, newsletters can be formatted in a reader-friendly way using colorful and fun 

designs. 

Examples 

from the 

Field 

In Juneau, Alaska, the WISEWOMAN program distributed a monthly newsletter that 

announced one-time and ongoing community events such as health fairs, walks, and 

fitness programs. The newsletter also listed the contact information of WISEWOMAN 

participants who would like an exercise partner, as well as available fitness resources such 

as gym discounts and free swimming programs. 

At Public Health Delta and Menominee Counties in Escanaba, Michigan, the 

WISEWOMAN program distributed a colorful quarterly newsletter that highlighted 

program events, health department and community events of interest to participants, and 

success stories of participants. Some women enrolled in the program who did not 

participate in the lifestyle intervention chose to return to the program because of the 

activities described in the newsletter. 

Staff Level of 

Effort: 

Staff might spend time writing newsletters and formatting them to be 

reader friendly. 

Other 

Considerations: 

Printing and mailing newsletters are considerations. 

Staff Skill 

Level and 

Training: 

Staff should have strong writing skills and possess some ability to 

format newsletters in a fun, reader-friendly way. 

Things to 

Consider 

Cultural 

Adaptability: 

Newsletter images and content can be adapted to the culture(s) of the 

priority population. 

Contact 

Information 

SEARHC WISEWOMAN Project 

Phone: 907-966-8710 (ask for WISEWOMAN Project Director) 

Michigan WISEWOMAN Project 

Phone: 517-335-1178 
Chapter VI: Maintenance 105

LONG-TERM PROGRAM PARTICIPATION

Practice(s) 8. Expand program services to meet additional needs of women (Project, Local) 

Description Projects and local sites can encourage long-term participation by adding activities that 

supplement the lifestyle intervention, such as classes, counseling, or peer support. To 

promote long-term engagement, high-performing local sites offered services on a frequent 

and ongoing basis and focused services in all targeted areas of behavior change (nutrition, 

physical activity, and tobacco cessation). 

Examples 

from the 

Field 

In Ware, Massachusetts, the site expanded on the standard lifestyle intervention— PACE 

and risk reduction education—that all women received. They provided women access to 

a hospital-based nutrition education program, coordinated smoking cessation classes, and 

made community resources available by offering women gift certificates to fitness and 

yoga facilities. The site also coordinated a monthly support group for interested women 

to discuss successes and challenges associated with making behavior changes. Women 

chose whether or not to participate in these additional services. 

Staff Level of 

Effort: 

Staff might spend considerable time organizing and coordinating 

activities on an ongoing basis. 

Other 

Considerations: 

Additional considerations are not anticipated. 

Staff Skill 

Level and 

Training: 

Staff should possess strong organizational and networking skills as well 

as related content knowledge or training to provide activities. 

Things to 

Consider 

Cultural 

Adaptability: 

Activities can be adapted to meet the cultural preferences of 

participants. 

Related 

Practices 

Chapter III, Effectiveness, Practice #4 

Chapter III, Effectiveness, Practice #12B 

Chapter III, Effectiveness, Practice #18 

Contact 

Information 

Women’s Health Network, Massachusetts WISEWOMAN Project 

Phone: 617-624-5434 
Chapter VI: Maintenance 106

LONG-TERM BEHAVIOR CHANGE

Practice(s) 9. Create strategies that focus on maintaining behavior changes in women (Project, Local)

Description Four strategies, which are described in the following tables, were identified as best 

practices to assist women in maintaining behavior change: 

10. Use incentives to promote maintenance of behavior changes (Project, Local) 

Link women to free or low-cost resources that support behavior change (Project, 

Local) 

Offer women opportunities for support from themselves and others (Project, Local) 

Conduct followup through telephone contact or e-mail (Project, Local) 

A focus group participant explained,“[Women] are more interested in having a listener and 

motivator. The majority of women know what it is they are supposed to do, but they need help and 

motivation to do it.” 

Examples 

from the 

Field 

Examples from the field of best practices that focus on maintaining behavior change are 

described in the tables for strategies 10–13. 

Things to 

Consider 

Things to consider for best practices that focus on maintaining behavior change are 

described in the tables for strategies 10–13. 

Contact 

Information 

Contact information for programs with best practices that focus on maintaining behavior 

change is provided in the tables for strategies 10–13. 
Chapter VI: Maintenance 107

LONG-TERM BEHAVIOR CHANGE

Practice(s) 10. Use incentives to promote maintenance of behavior changes (Project, Local) 

Description Projects can provide incentives to local sites, which in turn can distribute them to women. 

The incentives are specifically designed to help women maintain their behavior changes. 

For example, pedometers encourage women to walk and cookbooks with heart-healthy 

recipes teach women alternative ways to prepare favorite foods. Women described the 

incentives as “gifts” and reported feeling special when they received them. 

Examples 

from the 

Field 

The WISEWOMAN program at Public Health Delta and Menominee Counties in 

Michigan provided incentives to women that related to identified goals and encouraged 

women to maintain positive behavior changes. For example, the site encouraged the 

maintenance of physical activity by giving women water bottles, walking reflectors, 

pedometers, and, in some cases, walking shoes for women who could not afford them. 

Staff Level of 

Effort: 

Some time might be spent planning the types of incentives to use as 

well as ordering, purchasing, and distributing them to sites. 

Other 

Considerations: 

Projects and sites can distribute a variety of incentive types. Ordering 

in bulk ensures that the project or local site has a sufficient supply to 

target incentives appropriately to women. 

Staff Skill 

Level and 

Training: 

Some understanding of the community and the program is required to 

choose incentives that will be most effective in encouraging women to 

maintain their behavior changes. Little skill and training are needed to 

distribute incentives. 

Things to 

Consider 

Cultural 

Adaptability: 

Culturally appropriate incentives can be selected. 

Related 

Practices 

Chapter II, Reach, Practice #6B 

Chapter III, Effectiveness, Practice #22 

Chapter VI, Maintenance, Practice #2 

Contact 

Information 

Michigan WISEWOMAN Project 

Phone: 517-335-1178 
Chapter VI: Maintenance 108

LONG-TERM BEHAVIOR CHANGE

Practice(s) 11. Link women to free or low-cost resources that support behavior change (Project, 

Local) 

12. Offer women opportunities for support from themselves and others (Project, Local) 

Description Women benefit from supportive resources as they face the challenge of maintaining 

lifestyle behavior changes. Access to free or low-cost services in the community, support 

from an encouraging staff member, and opportunities to share experiences with those 

facing similar challenges are all forms of support that projects and local staff can provide 

to women. Projects and local sites can form partnerships with community organizations 

to increase the number of links to resources and opportunities for support. 

High-performing local sites promoted maintenance of behavior change by offering multiple

links to community resources to better match women’s individual needs. Some links, 

such as fitness program discounts, sought to reduce cost barriers to behavior change 

maintenance and others, such as the supportive environment at ongoing walking groups, 

strived to be motivational for women. 

Staff members can provide support directly to women by actively listening when women 

describe their challenges and progress and by providing encouragement when women are 

less motivated to practice healthy behaviors. High-performing local sites encouraged 

women to receive peer support by organizing support groups or informing women of 

existing groups in the community. Community support opportunities are valuable 

because they might be available to women who are no longer participating in 

WISEWOMAN, and they can offer the encouragement of peers in the community rather 

than staff members who might not identify with women’s personal challenges. 

Examples 

from the 

Field 

The Women’s Health Network program in Plymouth, Massachusetts linked women to 

multiple community resources to support their behavior changes. For example, the site 

offered women a free 3-week membership in a local health club and sessions with a 

personal trainer who designed an at-home workout. The site also offered opportunities 

for support groups. Women who had recently been diagnosed with diabetes or who are 

noncompliant with their treatment were offered the opportunity to participate in a 

diabetes support group through the hospital. The group provided education about 

nutrition and physical activity aimed at lowering blood glucose levels. The site also 

offered women individual and group sessions in a tobacco cessation treatment program. 

Staff Level of 

Effort: 

Identifying resources that offer support to women and establishing 

linkages to these resources might take time to initiate and sustain. 

Other 

Considerations: 

Additional considerations are not anticipated. 

Things to 

Consider 

Staff Skill 

Level and 

Training: 

Staff who identify and establish linkages to sources of support should 

have strong networking and organizational skills. Staff who provide 

support to women should have strong interpersonal skills. 
Chapter VI: Maintenance 109

Cultural 

Adaptability: 

Supportive resources can be culturally targeted, such as using counselors 

who speak the appropriate language or referring women to support 

groups with women from similar backgrounds. 

Related 

Practices 

Chapter III, Effectiveness, Practice #20 

Chapter III, Effectiveness, Practice #23 

Chapter VI, Maintenance, Practice #15 

Contact 

Information 

Women’s Health Network, Massachusetts WISEWOMAN Project 

Phone: 617-624-5434 
Chapter VI: Maintenance 110

LONG-TERM BEHAVIOR CHANGE

Practice(s) 13. Conduct followup through telephone contact or e-mail (Project, Local) 

Description Follow-up contact plays a key role in maintaining women’s behavior change because it 

shows women that staff are invested in their continued practice of healthy behaviors. Site 

staff are also able to address the individual needs of women in a supportive and caring 

way through these contacts. Staff members listen to women and stay current on their 

progress in adopting healthy lifestyle behaviors. Staff also function as a resource by 

offering information to help address women’s barriers to maintaining behavior change, 

encouraging women who have lost motivation, or providing tips related to maintaining 

behavior change goals. 

Examples 

from the 

Field 

The lifestyle intervention in Michigan was structured so that local site staff contacted 

women three to six times each year, often by telephone. Lifestyle counselors used these 

contacts as an opportunity to receive updates on women’s personal situations that could 

affect their maintenance of behaviors. Lifestyle counselors listened carefully to women’s 

progress toward goals and offer encouragement, support, and creative approaches to help 

women sustain healthy behaviors. 

Staff Level of 

Effort: 

Follow-up contact might take a substantial amount of time, depending 

on the number of times needed to reach women and the length of 

telephone calls or e-mail messages. 

Other 

Considerations: 

Additional considerations are not anticipated. 

Staff Skill 

Level and 

Training: 

Staff members who contact women should have strong interpersonal 

skills and knowledge of how to encourage women to maintain 

behaviors related to nutrition, physical activity, and smoking cessation 

and to address associated barriers. 

Things to 

Consider 

Cultural 

Adaptability: 

Staff who contact women should speak the appropriate language. 

Contact 

Information 

Michigan WISEWOMAN Project 

Phone: 517-335-1178 
Chapter VI: Maintenance 111

LONG-TERM BEHAVIOR CHANGE

Practice(s) 14. Identify ways to maintain positive changes and further improve risk factors (Project, 

Local) 

14A. Offer positive reinforcements for changes in risk factors (Project, Local) 

14B. Compare screening results from one year to the next for a longer term perspective 

(Project, Local) 

Description Projects and local sites can offer women encouragement and support to maintain positive 

changes in blood pressure, cholesterol levels, and other risk factors. Specifically, sites can 

discuss changes in risk factors with women, compare screening results from one year to 

the next, and provide women with positive reinforcement for changes. A strategy used by 

high-performing local sites was to have women identify their desired approach to 

behavior change. Depending on the structure of service delivery, staff have varied 

opportunities to discuss screening results with women. One frequently available 

opportunity is at the re-screening appointment. 

When local staff discuss screening results with women, they can take the opportunity to 

compare results from previous screenings to assess changes. High-performing local sites 

used past screening results to guide future intervention discussion and goal-setting 

activities. If staff identify improvements, they can capitalize on the moment by providing 

positive reinforcement. Also, staff might praise women for improvements in screening 

results and help women connect adopted behavior changes to their screening results. 

Examples 

from the 

Field 

The health educators at the WISEWOMAN program in Ludington, Michigan, focused on 

positive changes in screening results, which pleased women and encouraged them to 

complete the lifestyle intervention in the coming year. Women appreciated discussing 

these changes and enjoyed learning when they had made progress. The health educators 

noticed that women who did not change their annual re-screening results became 

discouraged. In these cases, the educators made an effort to focus on positive results and 

outcomes while attributing the lack of change to behaviors unrelated to women’s current 

goals. Women were then able to identify the behaviors they would need to adopt to 

experience improved screening results and with this knowledge they were able to choose 

behavior goals to work on in the future. 

Staff Level of 

Effort: 

Incorporating extra comments is not expected to take additional time; 

however, staff should have previous screening results available during 

their encounters with women. 

Other 

Considerations: 

Additional considerations are not anticipated. 

Things to 

Consider 

Staff Skill 

Level and 

Training: 

Staff should have a clinical background or training in the interpretation 

of screening results, and they should possess strong communication 

skills to help women understand the results and ways to address them 

on an individual basis. Re-training might be necessary because clinical 

guidelines change over time. 
Chapter VI: Maintenance 112

Cultural 

Adaptability: 

N/A 

Contact 

Information 

Michigan WISEWOMAN Project 

Phone: 517-335-1178 
Chapter VI: Maintenance 113

LONG-TERM BEHAVIOR CHANGE

Practice(s) 15. Identify resources to provide women access to needed medications (Project, Local) 

Description WISEWOMAN serves women who are uninsured or underinsured, which often means 

that women face financial challenges, such as not being able to afford needed medications 

to control chronic diseases. Sites can address this challenge by identifying prescription 

assistance programs in the community, such as hospitals, clinics, and nonprofit programs 

that offer free or low-cost medications. High-performing local sites actively sought out 

multiple resources that provided ongoing assistance because these provided a longer term 

benefit to women. 

Examples 

from the 

Field 

In Fayetteville, North Carolina, the WISEWOMAN staff informed women about the 

Medication Access Program, a source of free medications in the area. To ensure that 

women accessed the resource, staff proactively assisted women in completing the 

application and navigating the program’s waiting list. 

Staff Level of 

Effort: 

Staff time will be dedicated to identifying an initial list of resources and 

maintaining the list over time, as well as cultivating relationships with 

the programs. 

Other 

Considerations: 

Additional considerations are not anticipated. 

Staff Skill 

Level and 

Training: 

Staff who identify resources should have strong networking and 

organizational skills. 

Things to 

Consider 

Cultural 

Adaptability: 

N/A 

Related 

Practices 

Chapter III, Effectiveness, Practice #20 

Chapter VI, Maintenance, Practice #11 

Contact 

Information 

North Carolina WISEWOMAN Project 

Phone: 919-707-5301 
Chapter VI: Maintenance 114

LONG-TERM PROGRAM SUSTAINABILITY

Practice(s) 16. Increase the long-term sustainability of the WISEWOMAN program (Project, Local) 

16A. Integrate the WISEWOMAN program into other programs and into clinic or 

hospital services (Project, Local) 

16B. Develop partnerships for program sustainability (Project, Local) 

Description Multiple factors contribute to a program’s sustainability, namely resources, caseload, and 

capacity. Projects and local sites can also contribute to the program’s sustainability using 

other means, such as integrating WISEWOMAN into other programs and forming 

partnerships to solidify the program’s foundation in the community. 

WISEWOMAN services complement other services provided in hospitals and clinics. 

When WISEWOMAN is integrated into other programs and services, the program stops 

being a stand-alone service, which promotes sustainability within the clinic or hospital. In 

addition, integrating WISEWOMAN into other programs or services benefits women 

because they might receive a more comprehensive package of medical services. 

By forming community partnerships, sites can receive assistance in providing services that 

the program might not be able to offer alone, such as support groups or fitness activities. 

Developing community partnerships also increases awareness of the program by 

motivating organizations and providers to actively promote the program to their clients. 

High-performing local sites developed multiple community partnerships to increase 

program sustainability. 

Examples 

from the 

Field 

At the SEARHC clinic in Juneau, Alaska, WISEWOMAN program staff recognized the 

value of integrating the WISEWOMAN screening into other medical care services 

provided at the clinic. To promote the integration of WISEWOMAN and other services, 

staff informed clinic providers about the similarity of their services and developed a 

streamlined system for completing the WISEWOMAN screening without imposing an 

extra burden on the clinic providers. Through this integration, women benefited from 

less frequent visits to the clinic and WISEWOMAN benefited by developing a solid 

grounding within the clinic. 

In Sitka, Alaska, the WISEWOMAN program partnered with a variety of community 

organizations to increase its resources and capitalize on successful community programs. 

Partnerships with local schools, religious groups, nonprofit organizations, and native 

tribes have helped the program host events, provide incentives, and sponsor activities. 

Staff Level of 

Effort: 

It can take time to identify and establish relationships with appropriate 

and interested programs and partners. 

Other 

Considerations: 

As projects and local sites coordinate with other services and develop 

partnerships, they might engage in telephone communication or travel 

to other locations. 

Things to 

Consider 

Staff Skill 

Level and 

Training: 

Staff who identify and establish partnerships should have strong 

networking skills and a solid understanding of the WISEWOMAN 

program. 
Chapter VI: Maintenance 115

Cultural 

Adaptability: 

Partnerships can be formed with community organizations that target 

women of cultural groups that are also served by WISEWOMAN. 

Related 

Practices 

Chapter II, Reach, Practice #7 

Chapter II, Reach, Practice #8 

Chapter II, Reach, Practice #9 

Chapter V, Implementation, Practice #7 

Chapter VI, Implementation, Practice #8 

Contact 

Information 

SEARHC WISEWOMAN Project 

Phone: 907-966-8710 (ask for WISEWOMAN Project Director) 
ACTION CHECKLIST: 

MAINTENANCE—Sustaining WISEWOMAN 

Is the Project or Site 

Interested in Adopting 

this Strategy? 

LONG-TERM PROGRAM PARTICIPATION

1. Develop strategies to increase re-screening rates in local sites 

1A. Send multiple reminders to women about re-screening appointments 

1B. Use multiple modes of contact to reach women for re-screening 

2. Use incentives to encourage women to return for screening and intervention 

activities 

3. Develop practices that facilitate long-term participation in WISEWOMAN 

for interested women 

4. Update contact information for women during each visit or contact 

5. Institute a sense of belonging to the program through the use of membership 

cards that expire after 12 months 

6. Provide opportunities for WISEWOMAN involvement on an ongoing basis 

7. Distribute newsletters to all enrolled women 

8. Expand program services to meet additional needs of women 

LONG-TERM BEHAVIOR CHANGE

9. Create strategies that focus on maintaining behavior change in women 

10. Use incentives to promote maintenance of behavior changes 

11. Link women to free or low-cost resources that support behavior change 

12. Offer women opportunities for support from themselves and others 

13. Conduct follow-up through telephone contact or e-mail 

14. Identify ways to maintain positive changes and further improve risk factors 

14A. Offer positive reinforcements for changes in risk factors 

Chapter VI: Maintenance 116
Chapter VI: Maintenance 117

Is the Project or Site 

Interested in Adopting 

this Strategy? 

14B. Compare screening results from one year to the next for a longer term 

perspective 

15. Identify resources to provide women access to needed medications 

LONG-TERM PROGRAM SUSTAINABILITY

16. Increase the long-term sustainability of the WISEWOMAN program 

16A. Integrate the WISEWOMAN program into other programs and into clinic 

or hospital services 

16B. Develop partnerships for program sustainability 
Chapter VI: Maintenance 118

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APPENDIX A: 

SAMPLE TOOLS FROM SELECTED PROJECTS 

Name of Tool Chapter and Practice in which Tool is 

Described 

Page on which 

Tool Use is 

Illustrated 

1 Recruitment brochures from Nebraska Reach, Practice #1 12 

2 WISEWOMAN brief negotiation tool Effectiveness, Practice #5 37 

3 Lifestyle intervention log and master 

key from Nebraska 

Effectiveness, Practice #6 39 

4 WISEWOMAN goal progress chart 

from Michigan 

Effectiveness, Practice #7 40 

5 Goal-setting form from SEARHC Effectiveness, Practice #16, 17, 17A, 

17B 

47 

6 Goal-tracking forms from Plymouth, 

Massachusetts 

Effectiveness, Practice #16, 17, 17A, 

17B 

47 

7 Monthly Matters newsletter from North 

Carolina 

Adoption, Practice #10 75 

8 Healthy lifestyle assessment from 

Michigan 

Implementation, Practice #3 85 

Appendix A A.1
Appendix A 

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APPENDIX B: 

DESCRIPTIONS OF PROJECTS INCLUDED IN DATA-COLLECTION PROJECT 

Appendix B B.1
Appendix B B.2

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Appendix B B.3

Massachusetts WISEWOMAN Project and Lifestyle Intervention 

Project Description

The Massachusetts project is operated by the state department of public health. The Massachusetts 

project was one of the initial WISEWOMAN projects and first received funding in 1995. In 1998, the 

Massachusetts project formed the Women’s Health Network to offer comprehensive services to women 

participating in BCCEDP and WISEWOMAN by connecting them to primary care facilities. At the time 

of data collection (FY 2005), the Massachusetts project had contracted with 26 providers to deliver 

BCCEDP services; 7 of the 26 also provided WISEWOMAN screening and lifestyle intervention services. 

The contracted agencies included hospitals, visiting nurses’ associations, and community health centers. 

Some of the seven local WISEWOMAN sites also contracted with community providers to offer the 

screening services. 

Lifestyle Intervention

At the time of data collection, the primary lifestyle intervention used in Massachusetts was the PatientCentered Assessment and Counseling for Exercise and Nutrition (PACE) combined with risk reduction 

education (RRE). PACE is based on the Stages of Change model and includes (1) assessments of nutrition 

and physical activity behavior and (2) goal setting based on the results of the assessments. The physical 

activity assessment identifies the woman’s current level of activity as well as her ability to engage in 

physical activity. The nutrition assessment identifies the woman’s current nutrition habits in the areas of 

fruit and vegetable intake, dietary fat intake, and weight gain control. For each assessment, the woman 

receives a PACE score that identifies areas for improvement and her readiness to change in each area. 

The lifestyle intervention provides separate physical activity and nutrition counseling tools that correspond 

to each level of readiness: (1) not ready to change, (2) ready to change, and (3) actively changing. RRE 

used by the program focuses on educating women about the meaning of their screening results. 

At the time of data collection, the Massachusetts project was in the process of developing the Healthy 

Heart Program, which adapted the original PACE materials to have a lower literacy level and to be 

culturally appropriate for the women served. The Healthy Heart Program is available in Spanish, 

Portuguese, and Chinese; a low-literacy English version is also available. The Massachusetts project 

trained all of its educators in the Healthy Heart Program in November 2005 and began delivering the new 

intervention in January 2006. 

Supplemental Lifestyle Interventions. At press time, the local sites also offer women supplemental lifestyle 

interventions in the form of additional educational and experiential opportunities to support the adoption 

of heart-healthy behavior changes. The project must approve all supplemental interventions that local 

sites offer. Examples include (1) free sessions at a local gym with a personal trainer who develops a home 

exercise program for the woman, (2) free multi-session nutrition classes sponsored by a hospital, (3) free 

multi-session diabetes education, and (4) referrals to either a smoking quitline or a certified tobacco 

treatment specialist and nicotine replacement therapy. To offer these supplemental interventions, local 

sites must partner with local hospitals and community organizations. 

 

Staff Delivering Interventions at Local Sites

The Massachusetts project specifies the type of staff required to fulfill each role in the lifestyle 

intervention. The roles of staff, with their qualifications, are as follows: 
Appendix B B.4

• Clinician. A nurse practitioner or physician who completes the screening exam with the 

women. 

• Risk reduction educator. A nurse practitioner, registered nurse, or registered dietitian who 

discusses screening results with the women and provides the PACE lifestyle intervention, 

which includes education on risk factors, strategies for adopting lifestyle changes, and 

individual goal setting. 

Lifestyle Intervention Delivery

Program participants are screened in a clinical setting for cardiovascular disease risk factors and then given 

RRE. The initial meeting with the risk reduction educator typically occurs after the clinical risk factor 

screening exam. This can be done immediately following the exam (if the clinician and educator are in the 

same location) or at a later date (when screening is done through a subcontractor or the woman does not 

have time after the exam). RRE is completed in person or by telephone. 

Assessments of physical activity, nutrition, and smoking are either completed during the RRE visit or 

mailed to the women in advance and reviewed during the visit. Scores on assessments are used to identify 

areas for improvement, and staff work with the women to identify lifestyle change goals based on the 

results of the assessments. 
Appendix B B.5

Michigan WISEWOMAN Project and Lifestyle Intervention 

Project Description

The Michigan Department of Community Health received funding for its WISEWOMAN project in 2000, 

and the project began delivering services in 2001. At the time of data collection (FY 2005), the Michigan 

project contracted with 21 local coordinating agencies (LCAs) to offer BCCEDP in 82 of 83 counties in 

the state. All but one LCA was a health department. Several of the LCAs managed sites in multiple 

counties, depending on the region’s arrangement. Nine of the 21 LCAs also offered WISEWOMAN 

services. To provide WISEWOMAN services, the LCA must be able to deliver screening and lifestyle 

intervention services as well as ensure that women receive follow-up medical care either at the health 

department or in the community. 

Lifestyle Intervention

The intervention consists of individual lifestyle counseling contacts for all WISEWOMAN program 

participants. The Michigan project’s philosophy in delivering the lifestyle intervention is that ongoing 

support provided by a lifestyle counselor, rather than extensive educational information, encourages 

women to adopt heart-healthy lifestyle changes. Lifestyle counselors assist women in understanding the 

connection between their behaviors and cardiovascular risk factors and target their delivery of educational 

information to the interests of the women. The women are the decision makers and select their personal 

behavior changes. The state encourages all lifestyle counselors to use an “ask, don’t tell” approach and to 

provide positive reinforcement that facilitates the achievement of lifestyle goals. 

At the first lifestyle counseling meeting, a lifestyle counselor reviews the screening results with each 

woman, explains the meaning of the results, and describes lifestyle behaviors that can affect these results. 

The woman is encouraged to develop a lifestyle contract that includes goal setting related to nutrition, 

physical activity, or tobacco cessation. Nutrition goals reflect the dietary guidelines for Americans and 

U.S. Department of Agriculture food guide pyramid. Many forms of physical activity are encouraged 

(walking, exercise videos, etc.), and counseling on tobacco cessation includes a referral to a quit hotline. 

During lifestyle counseling follow-up contacts, the woman discusses her progress toward the goals, and the 

counselor documents her progress, offers encouragement, and makes referrals to community resources. 

The project recently revised the name of the lifestyle contract form to “Healthy Lifestyle Goals” because 

local sites reported that women reacted adversely to the word “contract.” 

Staff Delivering Interventions at Local Sites

Lifestyle counselors have at least a bachelor’s degree and represent a variety of disciplines, including 

nursing, dietetics, and health education. All staff members possess an understanding of cardiovascular 

disease risk factors and knowledge of how to counsel women on behavior change. 

Lifestyle Intervention Delivery

At the time of data collection, women were eligible to receive a varied number of contacts with the lifestyle 

counselor, depending on their screening results. In most cases, if a woman’s results were normal, she 

received only one lifestyle counseling contact, a face-to-face meeting that lasted up to 60 minutes. 

However, women with normal results who used tobacco and expressed an interest in quitting could 

receive two additional 15-minute follow-up lifestyle contacts by telephone to support their tobacco 
Appendix B B.6

cessation efforts. If a woman’s screening results were abnormal, the lifestyle counselor encouraged her to 

participate in five telephone or face-to-face counseling sessions, each lasting between 15 and 60 minutes. 

In July 2005, the project implemented a revised lifestyle intervention protocol that provided all women, 

regardless of screening results, with three to six lifestyle counseling contacts. The aim of the revised 

protocol was to simplify the program flow and to allow women with few or no risk factors to benefit from 

the lifestyle intervention. 
Appendix B B.7

Nebraska WISEWOMAN Project and Lifestyle Intervention 

Project Description

The Nebraska project is operated by the state department of health and human services. Nebraska first 

received funding in 2000 to provide WISEWOMAN services. To promote comprehensive care for 

women, the state unified WISEWOMAN and the BCCEDP into the Every Woman Matters program. At 

the time of data collection (FY 2005), services were available statewide through contracts with more than 

600 providers who conducted BCCEDP and WISEWOMAN screening. Women are recruited to the 

program by outreach workers at eight contracted agencies throughout the state. These workers also 

connect with previously enrolled women to encourage re-enrollment and make informational and 

supportive telephone calls to deliver the WISEWOMAN lifestyle intervention, which is administered by 

trained educators at the University of Nebraska’s cooperative extension services. 

Lifestyle Intervention

The Nebraska project uses two versions of its lifestyle intervention; one is taught in a classroom setting, 

and the other is a self-study course. 

ABC Class Lifestyle Intervention. The University of Nebraska’s cooperative extension services developed the 

ABCs for Good Health class curriculum, which emphasizes Aim for Fitness, Build a Healthy Base, and 

Choose Sensibly. This curriculum was developed by a health and wellness team for the University of 

Nebraska’s cooperative extension services in 1999 for use with clients taking part in cooperative extension 

services activities. 

The curriculum consists of four sessions that integrate educational materials, interactive lessons, and goal 

setting related to increasing physical activity, making positive nutrition changes, and improving overall 

health behaviors. Participants receive a notebook with relevant educational information and a pedometer. 

The classes provide an opportunity for women to prepare and sample heart-healthy foods, as well as an 

opportunity for weekly goal setting. At the beginning of each class, the educator reviews each woman’s 

progress toward her goal from the previous week. At the end of class, each woman sets a new goal for the 

coming week. The class series begins with physical activity lessons so that the women can monitor their 

walking throughout the four sessions and, ideally, continue to walk for exercise after the class has ended. 

To support consistent class attendance, outreach workers make a reminder telephone call to the women 

before each class. To promote the women’s healthy lifestyle changes and offer encouragement, an 

outreach worker attempts to contact the women for 6 months while they are still enrolled in 

WISEWOMAN but after they have completed the ABC class. 

Self-Study Lifestyle Intervention. The self-study materials (Be a WISEWOMAN – Get Heart Smart!) are 

offered as an option to participants who do not want to attend the ABC class. The project’s previous 

lifestyle intervention coordinator developed the five informational booklets that comprise the self-study 

materials based on the ABCs for Good Health class curriculum. 

The following informational booklets are sent to women on a monthly basis: 

• ABCs of Good Health (emphasizes physical activity) 

• Fruits & Vegetables 
Appendix B B.8

• Whole Grains 

• Straight Facts About Fat 

• Maintenance 

Along with the first informational booklet, the outreach workers send the women a notebook, pen, 

pedometer, and walking log to track their steps. The self-study information is presented clearly and 

concisely so that participants can easily understand each pamphlet. Mailings of materials are followed up 

with telephone calls, as described below. 

Staff Delivering Interventions at Local Sites

At the time of data collection, a combination of outreach workers and educators from the University of 

Nebraska’s cooperative extension services delivered the lifestyle intervention. The outreach workers made 

telephone calls to the women to ensure receipt of self-study materials, discuss goal setting, and provide 

support in making behavior changes. These workers did not require a specific background and they 

ranged from lay health workers to nurses. Educators with master’s degrees in education, home economics, 

or related disciplines delivered the ABCs for Good Health classes. 

Following data collection in 2005, the Nebraska project transitioned responsibility for intervention 

management from the outreach workers to a network of regional lifestyle interventionists and staff from 

federally qualified health centers. These people ensure that women complete the 6-month intervention 

process. A background in health education is required for regional lifestyle interventionists, and they range 

from registered dieticians to community health education specialists. 

Lifestyle Intervention Delivery

At the time of data collection, after a woman had been screened for cardiovascular disease risk factors and 

agreed to participate in the lifestyle intervention, an outreach worker was responsible for calling the 

woman to offer her the ABC class and self-study options. Each woman selected an intervention based on 

her level of interest and availability, but outreach workers strongly encouraged women to participate in the 

ABC class. 

The ABC class has an in-person didactic format, typically offered in four weekly sessions. Extension 

educators from the Nebraska cooperative extension services deliver the ABC class sessions. These 

educators, who are based in county offices throughout the state, are well versed in nutrition and physical 

activity, and they provide examples and tools that help the women assess their ability to make personal 

changes. Each educator aims to offer the ABC course series at least twice a year. 

The self-study intervention is delivered by mail and telephone. The women receive five mailings and 

follow-up telephone calls from outreach workers. During the calls, the outreach workers ensure that the 

materials were received, answer questions, discuss goal setting to achieve a healthy lifestyle, and support 

and encourage lifestyle changes as they are made. 

 
Appendix B B.9

North Carolina WISEWOMAN Project and Lifestyle Intervention 

Project Description

The North Carolina project is operated by the state department of health and human services. North 

Carolina had one of the original WISEWOMAN projects and first received funding in 1995. At the time 

of data collection (FY 2004), WISEWOMAN services were available in 40 of the 100 counties in the state. 

The project contracts primarily with county-level health departments to provide both screening and 

lifestyle intervention services. The health departments have the capacity to deliver services either by 

embedding WISEWOMAN into a pre-existing general clinic or by developing a WISEWOMAN-specific 

clinic at the site. 

Lifestyle Intervention

The North Carolina WISEWOMAN project uses A New Leaf: Choices for Healthy Living (New Leaf), a 

lifestyle intervention developed by researchers at the University of North Carolina–Chapel Hill (UNC) 

specifically to target the WISEWOMAN population in North Carolina. It emphasizes foods common in 

the southeastern United States. New Leaf was adapted from the Food for Heart nutrition intervention 

developed by Dr. Alice Ammerman at UNC. Food for Heart includes nutrition assessments and lifestyle 

counseling tools for use by a variety of health care providers. These assessments and counseling tools are 

expanded in New Leaf to include physical activity, smoking cessation, and osteoporosis education. 

 

New Leaf emphasizes individual tailoring, goal setting, and identification of barriers and perceived benefits 

of lifestyle changes. A component of the intervention is a behavior risk assessment with four sections that 

gauge (1) diet and barriers to dietary change; (2) physical activity, barriers to physical activity, and physical 

limitations; (3) smoking cessation; and (4) lifestyle risk factors for osteoporosis. Each risk assessment 

form uses a structured scoring template that quickly identifies areas of risk. 

The primary educational tools used in New Leaf are a manual or notebook and a cookbook with regionally 

appropriate heart-healthy recipes. The manual is organized by risk factor and includes tips for addressing 

risk factors identified in the assessment forms. It also has a section that provides tips on nutrition and 

physical activity to prevent and control diabetes. Other New Leaf materials include a practitioner’s 

training guide and Thera-Bands® (latex stretch bands) to facilitate physical activity. As the need arises, 

researchers at UNC develop new modules for inclusion in New Leaf. In 2005, for example, a weight-loss 

module was pilot tested with a cohort of women. Future plans include development of a leader’s guide to 

support implementation with a broader population of WISEWOMAN participants. 

 

Staff Delivering Interventions at Local Sites

Nurses employed by the health department are the primary providers of screening and lifestyle 

intervention services to WISEWOMAN participants. Some sites also involve other staff at the health 

department, such as health educators and nutritionists, in delivering the lifestyle intervention. 

Lifestyle Intervention Delivery

The project provides New Leaf intervention materials to all contractors without charge. Project 

contractors are encouraged, but not required, to use New Leaf materials. Counseling sessions can occur 

individually or in a group setting, and some sites provide a combination. Contractors deliver interventions 
Appendix B B.10

in person as well by telephone and mail. Counseling usually occurs during one or two sessions with a 

nurse at the health department. Although how the local sites deliver the lifestyle intervention varies, most, 

including all the sites involved in this study, use New Leaf. 
Appendix B B.11

SEARHC WISEWOMAN Project and Lifestyle Intervention 

Project Description

The WISEWOMAN project in Southeast Alaska is managed by the South East Alaska Regional Health 

Consortium (SEARHC). SEARHC receives funding from the Indian Health Service to provide medical 

services to Alaska Natives in the region and from the Health Resources and Services Administration 

(HRSA) to operate nine sliding-fee-scale community health centers. SEARHC first received funding for 

WISEWOMAN in 2000. Local sites operate with grant-funded staff based in two regional clinics, two 

sub-regional HRSA-funded clinics, and several smaller HRSA-funded clinics where staff provide program 

services through itinerant visits. 

Lifestyle Intervention

Standard Lifestyle Intervention. SEARHC offers what is called a “standard lifestyle intervention,” as well as a 

variety of educational and experiential activities to all participating women. Previously, the standard 

lifestyle intervention was individual counseling guided by the Traditions of the Heart (TOH) tool, but this 

intervention was recently redefined to provide staff more flexibility in what constitutes a standard 

intervention contact. Now staff can complete TOH with the woman or perform another type of 

intervention that meets CDC’s definition of a minimum intervention.9

 

TOH expands on and adapts the counseling tool A New Leaf: Choices for Healthy Living developed by 

Dr. Alice Ammerman and colleagues at UNC. TOH uses language that is culturally sensitive to Alaska 

Native women, includes nutrition and activity tips that have regional and cultural significance, and 

addresses all forms of tobacco use, among other adaptations. Included with TOH is a series of nutritional 

and physical activity assessments that women complete annually, a workbook that provides nutrition and 

physical activity tips and education, and a cookbook with a variety of heart-healthy recipes. In total, the 

nutrition assessment uses eight forms: 

• Fish, birds, and meat. 

• Dairy, eggs, cereal, and salt. 

• Fruits, vegetables, side dishes, desserts, and snacks. 

• Spreads, dressings, and oils. 

• How active are you? 

• Beverages. 

• What makes it hard to eat right? 

• What makes it hard to keep active? 

Each form is designed so that the most heart-healthy choice is in the far-left column and the least hearthealthy choice is on the far right. This design allows quick scoring and identification of areas for 

improvement. 

Staff apply motivational interviewing techniques when counseling women. This encourages the women to 

identify goals for lifestyle change instead of having the educator provide goals. Although the woman does 

much of the talking during the encounter, the educator asks for the woman’s permission to provide 

 9 CDC requires that all projects develop and submit a lifestyle intervention protocol for approval by the CDC project 

officer. (See WISEWOMAN guidance document, Chapter 5.) 
Appendix B B.12

education and advice on cardiovascular disease risk factors, including nutrition, physical activity, tobacco, 

and stress. If the woman is ready, the educator and the woman jointly set at least one behavior 

modification goal at the end of the intervention session. Women who are not ready to set a goal during 

this contact but are interested in making changes in the future are called within 1 month to assess their 

readiness to set a goal. Delivery of the standard lifestyle intervention takes between 40 and 90 minutes, 

depending on the woman’s situation. 

Educational and Experiential Activities. These are a major component of the lifestyle intervention. They offer 

women opportunities to participate in physical activity and to increase their knowledge of heart-healthy 

nutrition. In many instances, the opportunities for physical activity are experiential and occur on a regular 

basis, such as weekly swimming at the community pool or ongoing weight-lifting sessions. The 

educational activities typically focus on nutrition and are given either as a short series of classes on one 

topic or as a one-time event. The sites use existing curricula and develop original educational classes, often 

selecting topics based on participants’ expressed interests. Most sites schedule a variety of monthly 

gatherings that target physical activity and nutrition. Each site’s health educator is responsible for 

organizing and conducting these supplemental activities. 

When organizing gatherings and experiential activities, the project director affords significant flexibility to 

the health educators on the topics they may address. The primary requirement is that the activities support 

one or more of the four targeted cardiovascular disease risk factors—nutrition, physical activity, tobacco, 

and stress. 

To support the delivery of the lifestyle intervention, local staff build partnerships in the community with 

interested organizations. These partnerships vary across sites and include community pools, other physical 

fitness venues (gyms, yoga studios), and community buildings to host gatherings. Partnerships are viewed 

as mutually beneficial to the program and the partnering organization. Some sites also partner with 

participants to host gatherings in their homes. SEARHC emphasizes applying the socio-ecological model 

in its WISEWOMAN program, and partnerships with community organizations support the use of this 

model. 

Staff Delivering Interventions at Local Sites

SEARHC’s service delivery model is based on a two-person staff team (one person with a clinical 

background and one with a health education or community health background) at each local site. The 

staff member with the clinical background serves in the role of patient educator and has primary 

responsibility for enrolling and screening women and delivering the lifestyle intervention. The staff 

member with the community health background serves in the role of health educator or community 

wellness advocate, depending on his or her educational training, and has primary responsibility for 

coordinating experiential and educational opportunities. 

Lifestyle Intervention Delivery

A patient educator completes the standard lifestyle intervention with the women, typically during the 

enrollment or annual re-enrollment visit. The intervention can be completed after enrollment if the 

woman receives the WISEWOMAN screening during a visit to the clinic for another purpose. The 

standard intervention is provided either in person or by telephone. The assessments take about 15 

minutes to fill out and are typically completed during the intervention session. However, the assessments 

can be mailed to the women in advance, and the women complete them and bring them to the visit. 
Appendix B B.13

A health educator or community wellness advocate organizes the educational and experiential 

opportunities that complement the standard lifestyle intervention. Many of the education opportunities 

are in a class format with multiple participants. The experiential opportunities usually involve multiple 

participants and entail physical activity. The educational and experiential activities are typically offered in 

community sites (versus the clinic). All educational and experiential opportunities are optional for the 

women.