Integrating preventive health services within community health centers: lessons from WISEWOMAN.
BACKGROUND
Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) provides low-income, underserved women ages 40-64 with risk factor screening and lifestyle intervention and referral services to prevent cardiovascular disease (CVD). Integrating WISEWOMAN's services with the culturally appropriate medical care and support services offered by community health centers may improve the program's ability to reduce CVD burden among underserved women.


METHODS
We conducted a formative assessment of the perceived opportunities, challenges, and strategies associated with integrating WISEWOMAN into community health center settings. A panel of stakeholders that included health center and WISEWOMAN representatives was convened in 2002, and a semistructured discussion guide was used to elicit perspectives about integration. We also conducted an in-depth review of WISEWOMAN's history of collaboration with health centers in North Carolina.


RESULTS
Stakeholders perceived a clear need for integrating WISEWOMAN within health center settings, indicating that centers have few other resources to expand preventive services delivery and offer effective lifestyle interventions for underserved populations. Perceived barriers to integration included competing demands on health center resources, difficulties hiring staff for new programs, and administrative burdens associated with data collection and reporting. Experiences within North Carolina's WISEWOMAN project demonstrate, however, that lifestyle interventions can be designed in ways that facilitate integration by health centers.


CONCLUSIONS
Integration strategies need to be tailored to the resources, skills, and capacities available within health centers. As health centers and WISEWOMAN projects gain more experience in collaborating, additional research should be conducted to identify how best to achieve integration within specific institutional and community contexts.
Mays
Glen P
GP
Mathematica Policy Research, Inc., Washington, DC 20024, USA.
Hesketh
Heather A
HA
Ammerman
Alice S
AS
Stockmyer
Chris K
CK
Johnson
Tamara Lewis
TL
Bayne-Smith
Marcia
M
D000328:Adult; D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D003151:Community Health Centers / Q000458:organization & administration*; D003159:Community-Institutional Relations; D019033:Delivery of Health Care, Integrated / Q000592:standards*; D005260:Female; D006266:Health Education / Q000592:standards*; D006302:Health Services Research; D006801:Humans; D008875:Middle Aged; D020380:Needs Assessment; D009657:North Carolina / Q000453:epidemiology; D011203:Poverty; D011314:Preventive Health Services / Q000458:organization & administration*; D015397:Program Evaluation; D011795:Surveys and Questionnaires; D016387:Women's Health; D014932:Women's Health Services / Q000592:standards*