title: Implementing the WISEWOMAN program in local health departments: staff attitudes, beliefs, and perceived barriers.
abstract: BACKGROUND
  Although most health departments recognize the need for programs to reduce the risk of cardiovascular disease (CVD) among older, low-income women, they face numerous barriers to successfully implementing such programs. This paper explores counselors' attitudes and beliefs about patients and perceived barriers to implementing the North Carolina Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program.
  
  
  METHODS
  Health departments were assigned to provide patients with either an enhanced intervention (EI) or a minimum intervention (MI). Cross-sectional baseline and 12-month follow-up surveys were completed by health department counselors designated to deliver the MI or EI. Both surveys addressed counselors' beliefs about patients' motivation and attitudes, their counseling practices, and their personal diet and physical activity behaviors and attitudes. The follow-up survey also addressed opinions about the feasibility of long-term WISEWOMAN implementation.
  
  
  RESULTS
  Counselors were skeptical about patients' motivation to improve their lifestyle, citing high perceived cost and burden. At follow-up, EI counselors reported having higher self-efficacy for counseling, incorporating more behavioral change strategies, and spending more time counseling than did counselors at MI sites. They were also more likely to report making healthful personal lifestyle choices. All counselors identified lack of time as a major barrier to counseling, and most cited obtaining low-cost medications for patients, ensuring that patients made follow-up visits, and implementing the program with existing staff as key challenges to the long-term sustainability of WISEWOMAN.
  
  
  CONCLUSIONS
  Our findings provide insight into the organizational challenges of implementing a CVD risk-reduction program for low-income women. We discuss ways in which intervention and training programs can be improved.
authors.affiliation: Department of Nutrition, University of North Carolina, Chapel Hill, 27599, USA.
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Jilcott
authors.forename: Mary L
authors.initials: ML
authors.lastname: Macon
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Rosamond
authors.forename: Beverly A
authors.initials: BA
authors.lastname: Garcia
authors.forename: Larry K
authors.initials: LK
authors.lastname: Jenkins
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Cannon
authors.forename: Carolyn R
authors.initials: CR
authors.lastname: Townsend
authors.forename: Katherine W
authors.initials: KW
authors.lastname: Tawney
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Keyserling
authors.forename: Julie C
authors.initials: JC
authors.lastname: Will
authors.forename: Alice S
authors.initials: AS
authors.lastname: Ammerman
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D003376:Counseling / Q000592:standards*; D003430:Cross-Sectional Studies; D005260:Female; D006293:Health Promotion / Q000379:methods / Q000458:organization & administration*; D006801:Humans; D008875:Middle Aged; D020380:Needs Assessment; D009657:North Carolina / Q000453:epidemiology; D011203:Poverty; D011322:Primary Prevention / Q000379:methods / Q000458:organization & administration*; D015397:Program Evaluation; D011635:Public Health Administration; D011795:Surveys and Questionnaires; D016387:Women's Health; D014932:Women's Health Services / Q000458:organization & administration*