November 1996

Grant Results

SUMMARY

The National Black Women's Health Project, a self-help and advocacy organization committed to improving the health of African-American women, enhanced an existing 1991 demonstration project, "Walking for Wellness."

The project encouraged groups of 6 to 10 women to engage in 20-minute walks under a trained walking leader three times a week, and supported monthly health education and self-help meetings.

Key Results
In two years, the project accomplished the following:

  • Established 15 new "Walking for Wellness" programs in 10 cities, comprising some 400 walkers.
  • Recruited and trained 50 new walking leaders.
  • Created health and exercise literature, including a training manual for leaders and a "Starter Kit" for new programs.

Funding
The Robert Wood Johnson Foundation (RWJF) provided $175,000 from December 1993 to November 1995 to support the project.

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THE PROBLEM

Many low-income people in the United States do not receive basic, preventive health services and lack information about health maintenance and disease prevention. Homelessness, poor education, drug abuse, frequent crime, elevated stress levels, and an increased tendency toward a sedentary lifestyle disproportionately plague this group.

The 1990 National Health Interview Survey found that African-American women receive fewer basic, preventive health care services than their white counterparts. It also noted that 40 percent of African-American women are 20 percent or more above optimum body weight, compared with 23 percent of white women.

There is substantial evidence that the activity and fitness of black Americans, especially black women, are lower than for whites. Chronic disease risks associated with poor fitness include obesity and obesity-related conditions such as hypertension, coronary artery disease, diabetes mellitus, and osteoarthritis. These are conditions for which black women in the United States are at marked excess risk in comparison to other women. Evidence also suggests that raising physical activity levels will lower these risks. However, there has been virtually no research on strategies to engage black women in exercise, or to study its effects on their health.

The National Black Women's Health Project provides wellness education and services through self-help groups and chapters, and collects and disseminates information on health care issues facing African-American women and their families. Since its inception in 1981, the organization has grown to 96 self-help groups in 31 states.

Four pilot "Walking for Wellness" programs were established by the NBWHP beginning in 1991 in Los Angeles, Boston, Atlanta, and Gainesville, Fla., for small groups of low-income black women. The Ford Foundation supported this pilot program, with additional support from Prevention Magazine, local chapters of the American Heart Association, and, initially, the National Black Nurses Association.

Activities consisted of three 20-minute walks per week, and monthly meetings focusing on nutrition, self-care activities, and other health issues. In its pilot program phase, 1991–1993, the "Walking for Wellness" project created curriculum materials, recruited Olympic gold medalist Wilma Rudolph as a high profile spokesperson, and initiated four publicized walking events — in Orlando, Atlanta, Detroit, and Eatonville, Fla., the oldest black township in America.

Other Funding

Additional funds for the project came from the Nathan Cummings Foundation, which provided $75,000 (April 1993–March 1996); two individual donors, who provided grants of $25,000 and $20,000 in November 1993 and June 1994, respectively; and Nike, Inc., which contributed money and T-shirts.

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THE PROJECT

Operating from NBWHP's headquarters in Atlanta, project staff recruited and trained approximately 50 leaders in 15 stand-alone "Walking for Wellness" programs during the two year grant period. This augmented the four pilot programs already in existence at NBWHP chapters. Programs consisted on average of three groups of from 6 to 10 African-American women each.

The grantee created exercise and health education literature which was distributed to participants. It supported group walking leaders in monitoring and assisting walkers. These leaders conducted monthly self-help meetings to enhance participants' health awareness and to disseminate health information to participants, their families, and communities. NBWHP goals also included the provision of detailed health assessments and the integration of walking programs into their chapter organizations.

Communities in which at least 6 women expressed a wish to walk regularly, and in which a responsible group leader — to be paid a nominal amount per walk — were identified as program sites by the grantee. Local leaders were then trained, on-site, by national program coordinators.

Although, according to the grantee, they were "time consuming and labor intensive" to set up, programs had a high retention rate where they were integrated within the NBWHP chapter structure. However, several stand-alone programs disbanded for lack of coordination at the local level.

To measure walkers' progress, the grantee attempted to set in place a clinical health assessment regimen at each walking site. This goal was unreachable. Initially, the Black Nurse's Association agreed to volunteer some members to make health assessments at some walking sites. However, BNA was not set up locally to provide this kind of support, and this agreement failed. More fundamentally, the grantee found that providing the equipment and clinical environment needed to gather clinical data was not a realistic option at typical walking sites.

This grant funded, in part, annual "Walks for Wellness," held in conjunction with NBWHP national conferences — in Atlanta (1995); and Baltimore (1996). These walks attracted about 500 participants each. The grant also paid for the final editing and printing of a training manual, the completion and distribution of brochures, "starter kit" mailings, and the purchase of promotional T-shirts to be used in fund-raising walk-a-thons in 1997.

The grantee received many unsolicited requests for "Walking for Wellness" starter manuals in the course of this grant, but the rate of start-ups based on these requests was low, at best. Based on this experience, the grantee now insists that potential walking leaders be enrolled in a local chapter of the NBWHP and committed to the responsibility and necessary training. Only then are a starter manual and other literature sent.

Five walking programs have disbanded, bringing the total of programs still operating at the end of the grant period to 15, with between 270 to 450 walkers in total. Walking programs are still operating in 10 cities: Baltimore; Boston; Chicago; Dayton, Ohio; Idabel, Okla.; Tustin, La.; Stone Mountain and Decatur, Ga.; Conway, S.C.; and Fayetteville, N.C.

Ten programs are stand-alones; five are within NBWHP chapters. Four new programs are in development. Stated goals for the funded project were to train 60 walking leaders in 40 cities and enroll 7,000 walkers during the two-year grant period. Attrition and difficulties fostering local enrollment growth from NBWHP headquarters limited the project, and the goals were not reached.

In October 1995, as part of an institutional reorganization, the three Atlanta-based project staff were terminated by the NBWHP. Coordination of the program was assumed by the existing Public Education/Public Policy Office of the NBWHP, in Washington, D.C.

According to the grantee, this termination was a long anticipated part of an institutional reorganization and relocation. This move appears to have had an impact on the already slow growth of the grantee's funded initiative. Most visibly, 10 promotional walk-a-thons scheduled for 1996 were canceled or postponed (partly due to a decision not to go head-to-head with Olympics fund-raising). Finally, following the death of Wilma Rudolph, the planned recruitment of a new program spokesperson was dropped for almost a year.

Communications

Articles about this project appeared in Essence Magazine, Heart and Soul, and the New Age Journal during the grant period. To date, the grantee has distributed about 2,000 "Walking for Wellness" brochures, and 200 "starter" manuals both finalized and printed during the grant period. In 1994, NBWHP published its first book, Body & Soul, edited by Linda Villarosa, which extols the walking programs.

Since 1992, the "Walking for Wellness" program has also been the focus of a regular column in Vital Signs, NBWHP's quarterly newsmagazine. Ten thousand copies of this issue are typically distributed to a target audience of low-income black women, NBWHP members, and community organizers nationwide. Since 1993, NBWHP's annual conferences have featured "Walking for Wellness" workshops. In addition, in May 1994 Marcia Wells-Lawson, the national coordinator at the time, was interviewed on local Boston television. A videotape of that interview is currently used in presentations about the program.

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LESSONS LEARNED

  1. Grant-funded initiatives which are intrinsically local in nature, but whose support and nurture is to come from a national headquarters, are difficult to manage. Although NBWHP's project staff traveled extensively under this grant to train local leaders, it could not maintain strong administrative links where support from local NBWHP chapters was not also available. Lack of feedback from stand-alone programs, and subsequent program attrition, were significant problems. Grantee did not respond quickly to this problem, although it appeared to recognize it early on.

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AFTER THE GRANT

The grantee is not seeking more outside funding for this project. However, it does plan: to integrate new and current walking programs into existing NBWHP chapters and to make these programs self-supporting. Nationally, fund-raising for this will consist of walk-a-thons in cities targeted for new walking programs. Locally, NBWHP plans to use walkers' required enrollment fees in its chapters — dues are $25 per year — to further underwrite program costs.

Future programs will rely on simpler measures of walkers' progress, rather than a health assessment. Evaluations might include participants' weight and other physical measurements, plus subjective feelings of self-esteem, "wellness," attitude. The grantee will ask Chi Eta Phi, the national Black nurses' sorority, for volunteers to make these health assessments at program sites, and is considering similar partnerships with Planned Parenthood and the National Medical Association — in place of the failed arrangement with the National Black Nurse's Association for such support.

Five walk-a-thons will be held in 1997 — down from 10 planned for 1996, but postponed — to generate program publicity and for recruitment of new walkers, and to recruit a new spokesperson for "Walking for Wellness." In 1995, Jackie Joyner-Kersee was contacted and has expressed interest in the role. Discussions with her will be renewed.

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GRANT DETAILS & CONTACT INFORMATION

Project

Implementation of a Health Education Program for Low-Income Women

Grantee

National Black Women's Health Project Inc. (Dorchester,  MA)

  • Amount: $ 175,000
    Dates: December 1993 to November 1995
    ID#:  019874

Contact

Julia R. Scott
(202) 835-0117

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Horwitz AV and Reinhard SC. "Family and Social Network Supports for the Seriously Mentally Ill." Research in Community and Mental Health, 8: 205–232, 1995.

Horwitz AV and Reinhard SC. "Ethnic Differences in Caregiving Duties and Burdens Among Parents and Siblings of Persons with Severe Mental Illnesses." Journal of Health and Social Behavior, 36(2): 138–150, 1995. Abstract available online.

Horwitz AV, Reinhard SC and Howell-White S. "Caregiving as Reciprocal Exchange in Families With Seriously Mentally Ill Members." Journal of Health and Social Behavior, 37(2): 149–162, 1996. Abstract available online.

Reinhard SC and Horwitz AV. "Caregiver Burden: Differentiating the Content and Consequences of Family Caregiving." Journal of Marriage and the Family, 57: 741–750, 1995.

Presentations and Testimony

Horwitz, Allan V. "New Developments in Research on Families with Seriously Mentally Ill Members." NIMH Centers Meeting, New Brunswick, N.J., March 1996.

Horwitz, Allan V. "The Impact of the Closing of Marlboro State Hospital on the Quality of Life of the Seriously Mentally Ill." Panel Discussion Moderated by Geraldo Rivera. Marlboro State Hospital, October 15, 1995.

Horwitz, Allan V. "Siblings and the Care of Persons with Serious Mental Illness." Concerned Citizens Parents Association, Robert Wood Johnson Medical School, October 2, 1995.

Horwitz, Allan V., Reinhard, Susan C. "Family and Social Network Supports for the Seriously Mentally Ill." American Sociological Association, Los Angeles, Calif., August 1994.

Horwitz, Allan V., Reinhard, Susan C. "Policy Issues in Home Care for the Seriously Mentally Ill." Society for the Study of Social Problems, Miami, Fla., August 1993.

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Report prepared by: James Wood
Reviewed by: Marian Bass
Program Officer: Terri Gibbs

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