HOPE Works
2004-2009
Health, Opportunities,
Partnerships and
Empowerment
UNC Center for Health Promotion
and Disease Prevention
Alice Ammerman, DrPH, RD, Director
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Marci K. Campbell, PhD, MPH, RD (PI)
Salli Benedict, MPH, Project Director
Katie Barnes
Peggy Bentley, PhD
Brenda DeVellis, PhD
Andrea Meier, PhD
Kristine Kelsey, PhD
Chantelle Fisher-Borne, MPH
Beth Hooten, PhD
The evolution of the
Health Works projects
from participation to empowerment
Health Works for Women (HWW) 1993-1998
Work-site health promotion project focusing
on individual risk factors (diet and
exercise) and strengthening social support
networks
• Worksites included nine textile, apparel, and
light manufacturing companies in Eastern North
Carolina
• Project employed traditional research methods,
as well as formative research methods
The evolution of Health Works: From
participation to empowerment
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Health Works for Women/Health Works in the
Community (HWW/HWC) 1998-2003
• Scope of the project expanded to address
organizational and community factors that
impact health and well-being
• Community Advisory Committee (CAC),
consisting of workplace representatives, local
agencies, advocacy groups, established to
provide guidance and feedback
• Plant closings and lay-offs occurred in the
course of project implementation
The evolution of the Health Works
projects:
From participation to empowerment
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Health Works After the Flood (HWATF) 20002003
• In the wake of devastation wrought by
Hurricane Floyd in 1999, CAC members and
UNC initiated a project with CDC support to
address stress and IPV in the months
following the flooding
• Composition of the CAC changes to include
more community members, domestic
violence and mental health agencies, more
leadership rather than advice
Community Advisory Committee
October 2006
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Priscilla Allen
Katie Barnes, Chair
Sharon Brown
Tabatha Brewer
Consuela Combs
Darlene Leysath Dixon
Anne Doolen
Pamela Gonzalez
Addie Hall
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Barbara Harris
Katherine Hernandez
Judy Johnson-Truitt
Donna Kelly
Mary Bea Kolbe
Elizabeth Maynor
Pastor Patricia
Peterson (Co-chair)
Imani Rivera
Delphine Smith
Women’s Empowerment Days
Community Advisory Committee Project
2003
In response to community concerns
about the economic downturn and
the need for grassroots development
and empowerment efforts
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Planned and implemented by the
Community Advisory Committee
Address health and economic needs of
blue collar women
Community-wide events
New linkages among agencies
Community Partner: MBA
(Multicultural Business Association)
“Poverty is hazardous to women’s
health”:
The link between health and poverty
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Considerable micro-level research suggests a
strong relationship between individual health and
income (i.e. poverty leads to lower health status)
Important findings include:
• Income level is a more important predictor of health
status than income change
• Income level has a greater impact on the health status of
poor than high-income individuals
• Extended periods of time in poverty have a greater and
more negative impact on health than occasional episodes
of poverty
Phipps, S.
Loss of traditional industries in eastern
NC
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The manufacturing industry in the United States
has experienced extensive economic
restructuring in the past 30 years, primarily
affecting rural areas in the Southeast.
Between 1997 and 2002, North Carolina lost
100,000 jobs in the textile industry and 70,000
jobs in the apparel industry.
Hossfeld L, Legerton M, Keuster G.
Kalishman J, Stogner S, Ramey J.
HOPE Works
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Builds on HWW-1 and HWW-2/HWC
Community-based participatory research
project, active participation of Community
Advisory Committee
Addresses high prevalence of obesity…
…and addresses social determinants of
health (education, employment, living
situations)
Modeled on loan circles/microenterprise
HOPE Works Conceptual Model
Intermediate Outcomes
Health Determinants
Community factors
•Employment
•Housing
•Economic systems
•Education
•Culture and history
Environment factors
•Built environment
•Rurality
•Flood damage
and recovery
Individual factors
•Socioeconomic
•Language
•Culture
•Education
•Family
•Health status
HOPE Works
Intervention
Community level
•Neighborhood resources
•Opportunities for
learning and developing
capacity
•Community
development and
employment opportunity
•Community
involvement,collective
efficacy, social capital
•Health and obesity
prevention resources
•Partnerships/linkages
Individual level
•Goal achievement
•Self-efficacy
•Knowledge/awareness
•Skills and capacity building
•Social support
•Health behavior changes
Health and Social Change
Outcomes
Obesity prevention
Health promotion
Empowerment
HOPE
HOPE Works
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Intervention expands to larger
community, not just workplaces
Retain women’s health focus
Address link between health,
poverty, and hope
Goal setting
Uses third world community
development principles and models
Planning for HOPE Works
(2003-2004)
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CAC women trained to lead focus
groups (8 focus groups conducted)
CBPR Process/Committees formed:
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Facilitator training
Marketing
Kickoff
Evaluation (baseline and community surveys)
HOPE Works Intervention
HOPE Circles
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Low income, overweight women, multiethnic (African American, white, Latina,
Coharie Tribe)
Circles led by trained leaders from the
community
Experiential learning (fitness activities, ice
breakers, healthy food)
Provide social support, information,
strategies for health behavior change
Goal-setting in health and hope domains
(e.g. getting education, jobs, housing, etc)
Circle Leader Training
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Friday evening, all day Saturday
Experiential: ice breakers, fitness
activities (music), healthy food
Presentations on weight
management, healthy eating, fitness,
stress, economic empowerment
Goal setting: didactic and practice
Monthly meetings
HOPE Works Intervention
Tailored newsletters (6) that address
both health and hope-related issues
and goals
Community-wide events and
interventions; new focus on
advocacy
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Evaluation
--250 women in HOPE circles vs. 250
comparison women
• Individual change in weight, diet, PA,
hope, self-efficacy, social support,
community involvement, social capital,
psychological and economic well-being
--Comparison of HOPE Works counties
with neighboring counties via
random surveys (via mail)
• Health behaviors, awareness,
community involvement, social capital,
hope
Qualitative Evaluation of
Circle Leaders
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Personal life and health-related
changes in Leaders
Interviews, photo voice
Formative: intervention adaptations
Preliminary data: random
community surveys*
What do you believe is the single
biggest issue facing your community
today?
 Jobs and the economy
 Drugs/alcohol
 Social change/social capital
 Poverty
 Hispanic immigration
 Cost of health care, prescriptions
 Environment (hog, poultry farms, landfill)
*511 surveys: over 80% completed this question
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“No jobs. Most of the factories are
closing—send the work overseas. If they
keep this up no one will be able to buy
their products when it comes back to
America because no one will have jobs.
The gas prices have increased faster than
the cost of living increases in wages.
Depression is hitting everyone because
they cannot afford what they’ve been
having. No jobs, no pay increase, but
everything keeps going up. Yes
everything was better years ago. So
obesity and health problems are on the
rise. This problem will continue to
increase as long as there is no jobs and
depression from losing everything grows.”
“In my community we don’t have anywhere
for the children to go like a recreation
center and its hardly any stores or
restaurants where I live it’s a very small
town. Something about me I am 31 years
old, single mother with asthma. I have 3
children ages 10, 7 and 5. I would really
like to lose weight for my health and to do
more things with my children. I weigh
about 300 pounds right now. And its hard
for me to try and exercise because of my
asthma and then my breasts are real big.”
Preliminary analysis of random
community surveys : Hope
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Hope is significantly higher among
women with more education and
income, higher self-reported health,
more healthy days/month (BRFSS),
more positive perceptions of their
community’s economic and social
capital.
Hope higher among employed
women
Preliminary random survey
analysis: Hope
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Level of hope was not different by
age or race
Level of hope and body mass index:
there was significantly lower hope
among more obese (controlling for
age, race, and education)
HOPE Works…?
Will the HOPE Works intervention that
links health promotion/obesity
prevention with social support and
economic education/empowerment
result in positive health and hope
outcomes for women?
Seeds of HOPE
Goal: to create a sustainable model
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Born of growing interest in the importance
of economic empowerment to women’s
health and community development
Opportunities, training, education,
resources for enhancing economic
empowerment and community wealth
Community-led partnership w/UNC, CDC,
business and entrepreneurial
organizations: one-year participatory
strategic planning process
Seeds of HOPE Partners
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UNC (Jim Johnson, Anita Brown
Graham, Jesse White)
Community (community colleges,
economic development agencies)
Good Work
NC Rural Center
NCSU College of Design and Textile
School
Seeds of HOPE
Strategic Plan Goals
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Start a business that will serve as an
example of an exemplary workerowned business
Increase financial education across
all HOPE Works activities
Increase networking with
organizations that support
entrepreneurial activities
Threads of HOPE:
Creation of a
Woman-owned Business
The Seeds of HOPE strategic plan: to
create Threads of HOPE
Build on skills of unemployed
textile/apparel workers
Unique design or product to reflect
HOPE Works values, place and
culture
Collaboration with NCSU College of
Design (and Penelope Bags?)
Threads of HOPE Goals
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Training for low income women in
every aspect of running a business
Worker owned
Living wage
Health benefits
Health promoting business/HOPE
Circles
Leadership development
Opportunity to pursue educational
goals
Threads of HOPE Activities
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Collaboration with NCSU School of
Textile and College of Design
Student contest: unique Threads of
HOPE design
Meetings with community women
Ms. Tuggle’s Draperies
Contract with PRC Annual meeting