The WISEWOMAN projects: lessons learned from three states.
BACKGROUND
The WISEWOMAN program provides chronic disease risk factor screening, lifestyle interventions, and referrals to financially disadvantaged women who participate in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Three states (Arizona, Massachusetts, and North Carolina) participated in Phase One (1995-1998).


METHODS
Using a case study approach, we reviewed documents and conducted telephone interviews to compare the three projects' design and execution. The interviews, carried out in mid-2002, involved a convenience sample of project coordinators, project directors, researchers, and one CDC project officer (n = 9).


RESULTS
Many providers were overwhelmed by WISEWOMAN's research component and disliked its lack of flexibility. Researchers emphasized that high-quality evaluation requires resources and attention. Informants described the challenges of integrating WISEWOMAN with state BCCEDP programs that are in varying development stages and recommended changes in organizational culture and provider practices. Regarding implementation, informants emphasized the need for adequate and appropriate planning, buy-in, training, professional support, and outreach. Our sample also noted that WISEWOMAN projects tend to be labor intensive.


CONCLUSIONS
WISEWOMAN projects face challenges of integrating clinical and lifestyle interventions, reaching beyond a focus on individuals, marshaling substantial resources, and introducing complex interventions into stretched healthcare environments. The three Phase One projects were deemed successful in reaching underserved women, developing a more comprehensive women's health model, strengthening linkages to primary healthcare, experimenting with innovative behavioral interventions, and tapping into women's roles as social support providers and family/community gatekeepers.
Viadro
Claire I
CI
Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, USA.
Farris
Rosanne P
RP
Will
Julie C
JC
D000328:Adult; D001130:Arizona / Q000453:epidemiology; D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008019:Life Style; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D019982:Organizational Case Studies; D011314:Preventive Health Services / Q000458:organization & administration*; D016730:Program Development; D015397:Program Evaluation; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D035862:Vulnerable Populations; D014932:Women's Health Services / Q000458:organization & administration*