Healthy Women,
Healthy Futures: A
Model of
Interconception Care Su An Arnn Phipps PhD, RN, CNE
Director- Healthy Women, Healthy Futures
Assistant Professor, University of Oklahoma
College of Nursing
Problem
Oklahoma’s and Tulsa County’s Prematurity Rates are growing, HP 2006 2007 2008 2020 USA 12.8% 12.7% 12.3% 11.4% Oklahoma 13.9% 13.5% 13.4% Tulsa 11.5% 11.6% 12.1%
Problem
Oklahoma and Tulsa County IMR are Higher
(# deaths /1,000 live births)
HP
2005 2006 2007 2020
USA 6.7 6.7 6.3 6.0
Oklahoma 8.1 8.0 8.5
Tulsa County 8.2 8.7 9.4
Kuwait 9.0; Latvia 8.7; Macedonia 9.0;
Chile 7.7; Estonia 7.3; Cuba 5.8
Mapping Feto-Infant Mortality Tulsa County,
All Eligible Babies, 2003-2007 Infant Mortality Rate (IMR)= 8.8
Maternal Health/ Prematurity 3.6 (41%)
Maternal Care
1.5 (17.5%)
Newborn Care
1.5 (17.5%)
Infant Health
2.2 (28%)
Tulsa County 2003-2007
PPOR Map of Feto-Infant Mortality Rates All
Mothers
Maternal Health/Prematurity
White Non-Hispanic 3.1 (38%)
Black Non-Hispanic 7.3 (50%)
Maternal
Care
1.5 (17%)
Newborn Care
1.5 (17%)
Infant
Health
2.2 (25%)
Oklahoma Women’s Health Status
48th out of 51 states in women’s health
48th in women without health insurance.
Consistently ranks in the lowest 40 states in disease prevention or lifestyle behaviors.
• 40th in obesity
• 46th in leisure time physical activity
• 47th in smoking and in women’s mental health
• 48th in women’s annual dental visits
• 51st in eating 5 servings of fruits and vegetables each day
What is HWHF?
A multicultural, interconception women’s
health project based in the life course
perspective
Targets non-pregnant women in poverty
with children enrolled in four Tulsa Early
Childhood Education Programs
Provides services for two years
Mission
Improve the physical, emotional, social, dental, and vision health of non-pregnant women to reduce
premature birth and infant mortality
HEALTHY WOMEN, HEALTHY FUTURES Risks, Interventions & Outcomes
Women’s Environment of Poverty,
Stress, Isolation & Lack of Support A Culture of Respect and Support Healthy Outcomes
Decrease in Prematurity
Decrease in Low Birth Weight Infants
Decrease in Unintended Pregnancies
Decrease in NICU Admissions
Improvement in Women’s Knowledge, Behaviors and
Health Indicators
Medical Home and Dental Care
Health Promotion Education
Disease Prevention
Disease Management Education
Referrals for Mental Health and Treatment of Other Serious Health
Conditions
Assistance with Transportation and Translation
Nurse Educators, Health Navigators & Collaborating Programs
Behavioral Health
Substance Abuse
Domestic Violence
Depression & Other Mental Health Issues
Behavioral Health
Chronic Health Conditions
High Blood
Pressure
Diabetes Asthma High Cholesterol
Lifestyles
Smoking Poor Nutrition Lack of
Physical Activity
Ineffective Contraception
Dental Caries
Dental and Vision Care
Decreased Infant Mortality
Increase in Healthy Birth Spacing/ Reproductive Live Plans
Program Elements
Development of an individualized health plan by a “team” consisting of site nurse educator, health navigator, and woman through home visitation and risk assessment.
Assist women to establish a medical home, and /or reduce barriers to access to health services through community collaboration.
Provision of weekly group education on healthy lifestyles, illness prevention, health promotion and other content areas. Individual self management education as needed.
Program Elements
Address chronic psychological or biological responses to stress and learn stress control methods
Individual responsibility with a reproductive life plan
Peer social support
Intervention and monitoring of women’s health status and health behaviors for up to 2 years.
Participant Demographics (n=92)
Age 17 – 45 Average 29.3
Race/Ethnicity Marital Status
Black 15.9% Married 50.0%
Native American 2.3% Divorced 1.1%
White/Non-Hispanic 4.5% Single w/father 26.7%
Hispanic 78.4% Single n/w father 3.2%
Non-Hispanic 21.6% Alone 18.1%
Participant Demographics
Education Uninsured 91.4%
< 6th – 8th 15.1% Disabled 2.3%
9th - 12th 35.5%
H.S. Dip/GED 22.6% Employed
Some College/Tech 15.1% Full Time 7.5%
A.D. 3.2% Part Time 32.3%
B.A./B.S. 6.5% Unemployed 58.1%
Previous Pregnancy Risks
Premature Births 5.4% Very Low/ Low Birth Weight 10.6% Infant Deaths 6.4% Miscarriage 25.4% Births within 18 months 34.4%
Program Objective One & Outcomes
Improve women’s knowledge of
health promotion measures and
disease prevention practices
Pre and Post Test Comparison
71.2
62.1
76
65.8
71.7 70
61.7
66.2
92.1 89.5 88.6
78.8
90.9 93.2
90
85.5
0
10
20
30
40
50
60
70
80
90
100
Pretest
Post-test
Participant Comments
“ We learned information before, but didn’t
change. We now have an understanding and
can apply it.”
“ That I am learning things (in detail) that I did
not know before. I get amazed when I find out
things that I can do to prevent diseases.”
“The knowledge I have gained in the program
will stay with me for the rest of my life.”
Program Objective Two &
Outcomes
Assist women to improve their health
through development of healthy lifestyle
practices, including a reproductive life
plan, and by facilitating access to
services.
Initial Screenings and Assessments
58% got little to no exercise
32% ate 0-1 serving of fruits and vegetables/day
5% took a multivitamin (folic acid)
None take calcium
46.6% had positive depression screens
6% smoked
8% reported drinking alcohol
10% domestic violence relationships
2011 Participant Overview
Weight: Range 94-407 pounds BMI 15.6-63.7
Underweight 3.6%
Normal 30.1%
Overweight 22.9%
Obese 37.3%
Chronic Illnesses:
Diabetes = 5 (all uncontrolled)
Asthma = 4 Hypothyroid = 2
Hypertension = 2 Pre-hypertension = 8
Polycystic Ovary Syndrome = 1; Ovarian cyst = 2
Chronic STD = 3 ( herpes, HPV, etc)
Blood Pressure
81% entered with normal readings
17% had pre-hypertension
(120-139/80-89)
2% had Stage 1 hypertension
(140-150/90-99)
Cholesterol
91% began with TC levels < 200mg
85% at final screening (t=-1.704, p=.092)
HDL Cholesterol (good cholesterol)
Significant improvements (t=-6.211, p=.001)
Total/HDL ratio (indicator of CVD)
(t=3.745, p=.001)
Depression
Measured by PHQ-9
77% mild to minimal on admission
23% moderate, moderately severe, severe
Reduced to 13%
t=2.42, p=.018
Lifestyle Practices
Self report
How many days do you engage in exercise
that lasts at least 30 minutes at a time?
Mode increased from 0 at admission to 2 at
last screening.
t=2.407, p=.02
Daily Fruits and Vegetables
Self Report
“How many servings of fruits and vegetables
do you eat during a typical day?”
t=6.002, p=.001
Fat Content in Diet
Self Report
Very low in fat --- Very high in fat;
I don’t know
53% Medium in fat on admission
27% I don’t know
t= 6.470, p=.001
“Sugar” Content in Diet
Self Report
Range from low to high, and I don’t know
55% moderate on admission
22% did not know
t=3.102, p=.003
Pregnancy Planning
Maternal Risk
All women have developed reproductive life plans and say they want to space their children
22 women have become pregnant.
All received first trimester care.
21 pregnancies had adequate spacing of at least 24 months. (one at 22 months)
16 pregnancies were moderate to high risk
Infant Outcomes
3 infants born at 34-35 weeks (34.5 to 35.6 wks)
One in NICU for 10 days (hydrops). All at home, doing well
All infants’ weights were appropriate for gestational age.
Participant Feedback
“Becoming a participant is the best thing that
could happen to me”
“This program has changed my life and that
of my family.”
Participant Feedback
I am cooking healthier for myself and my family.
My children are eating more fruits
and vegetables
I lost weight and was taking better care of myself. I felt more confident that my baby would be healthier. My delivery was easier.
Participant Feedback
My 12 year old daughter has lost weight too
and has become more physically active. She
has a better self esteem.
My husband is complaining. Why are we
thinking only of the women?
Thank you for the help – for health, well being
and support
Contact Information
Su An Arnn Phipps R.N., Ph.D., C.N.E
Director-Healthy Women, Healthy Futures
University of Oklahoma College of Nursing
918.660.3955