An examination of the implementation of the CDC’s WISEWOMAN program in Illinois supports community-specific tailoring and developing and testing innovative strategies to reach uninsured women through health coaching with motivational interviewing.

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Cardiovascular disease (CVD) is the leading cause of death for women in the US. The burden of CVD is particularly great for low-income women without health insurance. Uninsured women have limited access to preventive care, so they might not be aware of their CVD risk. They may also face challenges with managing CVD risk factors, and without intervention, their risk factors may continue to escalate. Therefore, they have a greater chance of developing and dying from CVD. To address this problem, the Centers for Disease Control and Prevention (CDC) created the Well-Integrated Screening and Evaluation for WOMen Across the Nation (WISEWOMAN) program.

WISEWOMAN provides screening and preventive health services to low-income, uninsured women ages 40 to 64 to identify CVD risk factors and intervene to prevent or delay CVD. One such intervention provided in Illinois is health coaching. Health coaching, especially when combined with motivational interviewing (MI), can provide crucial support through personalized guidance to improve health outcomes. In our study “Implementation and Reach of Health Coaching Using Motivational Interviewing to Reduce Cardiovascular Disease Risk in Uninsured Illinois Women,” we evaluated the implementation of health coaching to address CVD risk among uninsured women served by the Illinois WISEWOMAN Program (IWP).

Between 2019 and 2023, the IWP served over 3,000 clients through eight local health departments and federally qualified health centers in urban, suburban, and rural communities throughout the state. IWP clients represented a range of demographic characteristics, including race/ethnicity and level of education, and many entered the program with existing CVD risk factors such as high blood pressure, insufficient physical activity levels, or a body mass index, classifying them as overweight or obese.

IWP partner agencies recruit clients from the National Breast and Cervical Cancer Early Detection Program. Clients who enroll in WISEWOMAN receive screenings that include their blood pressure, blood cholesterol, blood glucose, height, and weight, followed by risk reduction counseling to discuss screening results. Additionally, clients are offered one-on-one health coaching with motivational interviewing using a four-session, theory-based, and evidence-based curriculum. Health coaching sessions are tailored to each client’s risk factors, individual goals, and circumstances.

In our study, we sought to better understand best practices related to the delivery and reach of motivational interviewing to address CVD risk in uninsured women. To do this, we analyzed standard information collected from all IWP clients between 2019-2023 to evaluate within-agency differences in health coaching participation and completion rates.

What we found:

• Among 3,094 IWP clients, 89.7% participated in at least one health coaching session.
• At four of the eight IWP sites, over 90% of clients participated in at least one health coaching session. At an additional two sites, over 80% of clients participated in at least one health coaching session.
• Despite high participation rates, only 31.4% of IWP clients “completed” health coaching by attending at least three sessions.
• At four of the eight IWP sites, over 85% of all IWP clients were health coaching completers. Completion rates range from <1% to 45.5%.
• Within agencies with sufficient client variation to evaluate health coaching participation and completion, we did not find any client-related patterns to predict engagement in health coaching.

Our findings highlight the acceptability of health coaching with motivational interviewing in the target population. However, due to within-agency differences related to populations served and community context, IWP agencies have developed strategies to reach their client populations in ways that address client- and community-specific barriers and facilitators. Importantly, IWP agencies must address socioeconomic and structural barriers that can limit the ability of uninsured women to participate and complete multi-session health coaching interventions.

Implications:

To maximize the impact of interventions such as health coaching with motivational interviewing, agencies should focus on developing and testing tailored strategies that consider the unique challenges faced by low-income and uninsured populations. By improving accessibility and engagement, we can better support uninsured women in managing their cardiovascular health. Future studies should also evaluate the effectiveness of community-based implementation of health coaching with motivation as a way to reduce CVD risk in uninsured populations.

To learn more about our study and its findings, read “Implementation and Reach of Health Coaching Using Motivational Interviewing to Reduce Cardiovascular Disease Risk in Uninsured Illinois Women” in Vol. 2 of special issue of the Journal of Public Health Management and Practice, highlighting cardiovascular disease prevention efforts among state and local health departments. 

Acknowledgements

We would like to acknowledge the co-authors who contributed to this work: Ravneet Kaur, DrPH, and Manorama Khare, PhD, from the University of Illinois College of Medicine Rockford; Liyong Cui and Leslie Carnahan, PhD, from the School of Public Health, University of Illinois Chicago; and Pam Jefferies and Phallisha Curtis from the Illinois Department of Public Health.

Kristine Zimmermann, PhD, MPH, is an assistant professor in the Department of Family and Community Medicine, University of Illinois College of Medicine Rockford, and has affiliations with the University of Illinois Chicago’s School of Public Health and Center for Research on Women and Gender. She is a public health researcher with expertise in women’s health, rural health, and chronic disease prevention.

Chloe Ford, MSc, is a research associate II in the Health Research and Evaluation division of the Department of Family and Community Medicine, University of Illinois College of Medicine Rockford.