For residents in rural counties of eastern North Carolina, prolonged stress from unemployment and low income, lingering problems from Hurricane Floyd in 1999, and high rates of obesity have increased their risk for chronic diseases. These factors combined to discourage many area residents from making positive changes in their lives. Women in these counties reported they could not improve diet, manage stress, increase exercise, or lose weight when they were concerned about employment and supporting their families.
Working with the center’s community action council (CAC) researchers developed a project to help the women improve their economic status, increase their sense of empowerment, and adopt healthy habits. The CAC helped plan and implement the Health, Opportunities, Partnerships, Empowerment (HOPE) Works intervention in two economically disadvantaged North Carolina counties, Sampson and Duplin. Researchers and the CAC analyzed information from a pilot project, feedback from women’s focus groups, and recommendations from the Community Guide to Preventive Services. The project team combined guidance from these sources to develop and evaluate the project.
The primary intervention was support groups called HOPE Circles. Researchers trained more than 30 women from the community to be HOPE Circle facilitators. They conducted biweekly, 2-hour meetings for 348 women over 6 months. Approximately 390 women in Lenoir and Bladen counties were recruited into a nonintervention comparison group. At the meetings, women learned strategies to manage stress, prevent and control obesity, and overcome barriers to changing eating and exercise habits. Facilitators encouraged each group member to set at least one health behavior goal and one life improvement goal. Participants also received tailored newsletters containing health tips.
In the intervention group, 252 women completed baseline and 6-month follow-up surveys about healthy eating, physical activity, and mental and emotional wellness. Researchers collected the same information from 278 women in a comparison group. Preliminary analysis of survey data show that HOPE Circle participants improved on several measures; full data analysis and reporting are in progress. In the meantime, researchers have disseminated reports describing the HOPE Circle process.
During the HOPE project period, researchers added two more activities to understand and meet local women’s needs. Seeds of HOPE included a series of meetings between community members, several schools at the university, economic development organizations, and the small business center of a local community college. The meetings focused on developing a strategic plan for incorporating small business development into HOPE Works. This cross-sector collaboration produced Threads of HOPE, Inc., a community-owned business, which produces cotton tote bags and provides workers with a living wage, training in textile production and business management, health insurance, a chance to pursue higher education, and access to health promotion interventions—mostly about nutrition and physical activity. Now center staff and community partners are implementing and evaluating Seeds of HOPE in four counties.
In 2004, researchers mailed a community survey to a random sample of 2,500 women in the comparison and intervention groups. The survey included an open-ended question asking respondents to name the biggest challenge facing their community. More than 540 women responded to the survey and 411 wrote answers about community challenges. The CAC analyzed the responses and developed policy briefs for the state legislature. In 2009, researchers mailed follow-up surveys to respondents and more than 340 were returned, providing a snapshot of the status of women in the project’s service area. The CAC and researchers will analyze the data in hope of developing further policy initiatives and advocacy training for CAC members. Researchers also will analyze the survey data to assess changes that may be attributable to HOPE Works.