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

Su-Phipps@ouhsc.edu