WISEWOMAN Best Practices Toolkit:
Lessons Learned from Selected Projects
Chapter I: Methods Used to Identify Best Practices
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The detailed methods for identifying best practices have been published
and are available on the Web at
http://www.cdc.gov/pcd/issues/2006/jan/05_0133.htm free of charge. 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. 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.
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. 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). 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.
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.
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 RE-AIM dimensions. A best practice related to a
given RE-AIM dimension (e.g., Reach) could therefore be 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.
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Page last reviewed: July 10, 2007
Page last modified: July 10, 2007
Content source: Division
for Heart Disease and Stroke Prevention,
National Center for Chronic Disease Prevention and
Health Promotion
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