Tailored Approaches: Increasing the Effectiveness of Community Interventions for Marginalized Women

Posted on June 14, 2024 by Ashwini Chaudhari

This entry is part 1 of 7 in the series CVD Prevention 1

Mujer Poderosa, a government-funded program in Pennsylvania, shows the importance of tailoring program approaches to communities to improve the cardiovascular health of marginalized women.

Need for tailoring Mujer Poderosa

Read the Article in JPHMP

Pennsylvania Department of Health (PADOH) implemented Mujer Poderosa/Powerful Woman (MP/PW) across the state in 2018. MP/PW is the Pennsylvania branding of an innovative approach to the Centers for Disease Control and Prevention’s (CDC) WISEWOMAN program. The program was created to empower Latina women to take charge of their cardiovascular health, using culturally relevant practices across a range of communities. To achieve this, PADOH partnered with Latino Connection (LC). LC is a community-based organization well versed in providing culturally relevant practices to women of color. Latina women in Pennsylvania come from 20+ countries across North, Central and South America. They vary in education, immigration status, income and level of US acculturation. LC Community Health Workers (CHWs) had to look beyond the traits of individual women to community characteristics. For example, women in one community were less likely to admit having unmet needs or to request assistance. Women in another community were generally more tech savvy. In another community, women were more distrustful of CHWs. CHW experiences demonstrated that to engage women in meaningful ways, they must understand and adapt to individual and community norms and characteristics. It became clear that strategies used to build trust in one community may not work in others. So, MP/PW tailored approaches while engaging dissimilar communities. As evaluators with the Evaluation Institute for Public Health at the University of Pittsburgh, we conducted a thorough evaluation of MP/PW’s efforts to improve the health of participants. We evaluated the program for its sustainability and impact. More information on the program is presented here.

What did tailoring look like in MP/PW?

CHWs gauged community characteristics like the preferred method of communication, common work schedules, literacy levels, attitudes and values, and tailored activities accordingly. For example, they discovered that women in one community had much lower levels of Spanish readability. In response they changed print materials to simplify language and provide illustrations. LC CHWs delivered MP/PW health coaching sessions. They worked around women’s busy work schedules, and social distancing challenges posed by COVID-19. CHWs provided virtual coaching sessions and used texting app groups in tech savvy communities. They provided telephone coaching sessions for others.

With the rising cost of food items, CHWs educated women on the economic and health benefits of home cooking over store-bought meals. CHWs provided cooking tips and healthy modifications. They educated women about hidden sugars and salts in prepared foods. They provided storage containers for meal prepping in advance. They encouraged healthy dietary habits keeping in mind the ingredients used in specific Latino cultures as well as grocery supplies available in the community.

Evaluation findings

We found that CHWs’ use of culturally relevant tailored approaches left a long-lasting impact on participants. Personalized contact and messaging groups with other participants promoted a sense of companionship and built friendships. Meeting as a group and being allowed to bring friends or relatives provided peer support and helped to improve participants’ self-confidence. CHWs’ ongoing personal contacts with women provided them support and encouragement. CHWs were able to build trust within communities and relationships with participants. Many women maintained contact with CHWs past the end of the program, asking questions and sharing successes. Most importantly, women and the family members/friends/peers who tagged along for the sessions began putting their health before other duties.

Our recommendations

We encourage federal funders to support programs with innovative and flexible approaches and not ‘one size fits all’ interventions. Tailoring public health interventions is not a new concept. However, government funded programs are in a strong position to practice tailoring for large scale public health interventions. These programs are more likely to have significant resources, expertise, and professional connections available to them. Tailoring, based on the intended program recipients and context, improves the effectiveness of interventions.

Programs should share the tailored approaches used with other programs for their consideration, modification and adoption. Peer-to-peer conversations will stimulate fast sharing of effective practices in public health program implementation and evaluation. We would also like to stress the importance of collecting qualitative data from program participants and providers to help inform tailoring decisions, as well as share valuable feedback for modifications along the way. For more information, read the full article published in the Journal of Public Health Management and Practice.

Funding Statement: The funding for the MP/PW program was provided by CDC through WISEWOMAN (Well-Integrated Screening and Evaluation for Women Across the Nation) Innovation grant.

Acknowledgement of co-authors

Dr. Thistle Elias, DrPH, MPA, is the senior Associate Director of the Evaluation Institute for Public Health at the University of Pittsburgh. She was the principal investigator of the evaluation team for the Program.

Molly M. Eggleston, MPH, CPH, MCHES, and Sarah Papperman, MPH, CPH, are members of the Evaluation Institute for Public Health at the University of Pittsburgh.

Recommended articles

Park Y, King J, Eggleston MM, Elias TI. Critical Lessons in Tailoring Interventions: Listening to WISEWOMAN Participants. American Journal of Health Promotion. 2024;38(1):90-100. doi:1177/08901171231200779

About the Author

Ashwini Chaudhari: Ashwini Chaudhari is a rising first year doctoral student at University of Pittsburgh School of Public Health. She supports the Evaluation Institute for Public Health across multiple projects including the Pennsylvania WISEWOMAN program. She holds an MPH from Boston University and an undergraduate degree in Dental Surgery from India.