Susanne Pickering, MPH, MS, OTRL, CHES

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• Susanne Pickering, MPH, MS, OTR/L, CHES
• CAPT, US Public Health Service
• Regional Womens Health Coordinator, Region IV
• Office on Womens Health
• U.S. Department of Health and Human Services

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• Purpose
• To provide parents/caregivers with tools
  strategies to improve family eating and activity
  habits
• To promote parent self-efficacy
• To support adolescent girls in reaching and
  maintaining a healthy weight
• To prevent obesity among adolescent girls

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• Primary audience
• Parents and caregivers of adolescent girls
• Secondary audiences
• Adolescent girls
• Other family members

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• Main Messages
• Healthy girls become
• strong women

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• Main Messages
• Parents are an important influence
• on their childrens eating and
• activity habits

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• Main Messages
• Change takes time begin by
• taking a few small steps

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• Formative Research
• Literature review
• Steering committee of researchers, providers,
  government officials, including
• Kelly Brownell, Ph.D., Yale University
• Tom Robinson, MD, Stanford University
• Kelly Moore, MD, Indian Health Service
• 16 focus groups with
• Girls ages 11 to 13 (8)
• Middle-school nurses (2)
• Parents of middle school-aged girls (6)
• Telephone interviews with health care providers
  (9)

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• Program Components
• BodyBasics (Parents Guide)
• Food and fitness journals
• Weekly planner (refrigerator magnet)
• 4Teens Magazine
• Recipe book
• Shopping list
• DVD on shopping cooking
• Pedometers
• Training Manual for Parents
• Train-the-Trainers Guide

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• Approach
• 7 Simple Steps to Healthy Living
• Decide to live a healthy lifestyle
• See where you are now
• Understand healthy eating
• Recognize the benefits of physical activity
• Set goals and plan
• Shop, cook, eat together
• Support a healthier lifestyle for your family

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• Train-the-Trainers Guide
• 6-hour session
• Inserts (USDA Dietary Guidelines, PowerPoint
  Presentation CD, templates for recruitment
  materials, and instructions for ordering
  toolkits)
• Appendices
• A. Training Tips
• B. Behavior Change
• C. Resources
• Training Manual for Parents
• Lesson Plans for 10 sessions
• Consumer brochure

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Community-Based Approach to Distribution

• OWH Regional Offices contacted for
  training-the-trainers session
• RC and trainers provide training to regional
  community-based organizations (CBOs), Centers of
  Excellence (COEs), Community Clinics of
  Excellence (CCOEs), and State Health Departments
• Trained professionals will
• Order toolkits
• Recruit parents/caregivers
• Disseminate kits at kickoff meeting
• Conduct 9 follow-up weekly meetings with
  parents/caregivers
• Train others to be trainers

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Sample Spreads for American Indian/Alaska Native
and Spanish-Language BodyWorks
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American Indian/Alaska Native BodyBasics
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American Indian/Alaska Native Recipe Book
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Spanish-Language BodyBasics
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Primary Channels of Distribution

• Office on Womens Health (OWH)
• 10 OWH Regional Offices, COE, CCOEs
• State health agencies
• Community-based organizations
• Health professionals
• (physicians, nurses, dietitians)
• Hospitals/clinics
• Faith-based organizations
• Non-profits (YMCA, schools, foundations)

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BodyWorks Trainers

• Trainers identified through channels of
  distribution
• Six-hour sessions held in small groups of 1015.
• Trainees receive kits, two training manuals, and
  follow-up technical assistance
• New trainers are prepared to train other trainers
  as well as parents/caregivers.

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Trainers train other Trainers

• Trainers identify potential facilitators and set
  up local sessions.
• Trainers order toolkits online from OWH website
• Electronic files of training manuals are sent to
  trainers.

Trainers train Parents/Caregivers

• Trainers recruit 10 to 12 participants
• P/Cs attend eight to ten 90-minute sessions,
  usually weekly,
• P/Cs receive toolkit at no charge to take home.
• Trainers order kits and manuals from website

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42 States and Puerto Rico with BodyWorks Trainers
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BodyWorks Website

• www.womenshealth.gov/BodyWorks/trainers/
• Trainer resources
• Recruitment materials
• Marketing materials
• Ordering instructions
• BodyWorks Listserv
• Frequently Asked Questions
• Locating other trainers
• How to become a trainer
• Templates for news releases

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LISTSERV

• BodyWorks trainers have access to
• Lessons learned
• Best practices
• General advice from OWH and other trainers
• Opportunity to ask questions and offer
  suggestions

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Evaluation Objectives

• Determine the most effective strategies for
  successful implementation of BodyWorks
• Evaluate impact on knowledge, awareness,
  attitudes and practices of parents and girls
  regarding nutrition and physical activity
• Focus on initiating behavior changes

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Data Collection

• Six organizations as evaluation sites
• Pre- and post-questionnaires(300 parents and 100
  girls)
• Telephone interviews with administrators from
  each of the six sites
• Questionnaire about training experience (all
  program trainers)

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Parent/Caregiver Training Challenges

• Effective and timely recruitment of
  parents/caregivers
• Parent/caregiver retention, attendance and
  participation in 10 sessions (time, childcare,
  transportation)
• Insufficient readiness of parents/caregivers to
  make healthier changes re eating/activity
• Not admitting children are obese/overweight
• Not seeing the link between overweight and
  chronic diseases
• Not ready to make changes

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Parent/Caregiver Training Challenges

• Lack of basic parenting skills
• Low-literacy skills
• Resources/funding for healthy snacks, incentives,
  speakers, field trips, demos, and replication of
  training materials

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Train-the-Trainer Challenges

• Identifying appropriate trainers
• Time constraints of interested trainers
• Locating funding for to conduct training and
  produce materials (manuals)

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Why BodyWorks Training or Toolkit?

• The top four reasons for parents/caregivers to
  train are
• Wanting to learn more about nutrition (75)
• Being concerned for familys health (68)
• Wanting to learn how to cook healthier meals
  (66)
• Being concerned for their own health (60)

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Outcomes Demonstrated

• Parents/caregivers in the intervention group
  were significantly more likely than parents in
  the comparison group to report the following
  behaviors after completing the BodyWorks than
  before participating in the program (based on a
  scale of 1-5)

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Effect on the parents nutrition and physical
behavior

• Being more physically active (post-test mean
  scores 4.2 versus 3.6)
• Changing how much they ate (4.2 versus 3.5)
• Shopping for healthier foods (4.3 versus 3.7)
• Making healthier food choices (4.3 versus 3.7)
• Trying to make school or community change (3.2
  versus 2.3)
• Helping daughter be physically active (3.9 versus
  3.3)
• Helping daughter to make healthy food choices
  (4.2 versus 3.6)
• Doing more active things with daughter (3.9
  versus 3.2)

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Next Steps

• Print 4Guys magazine for boys
• Complete Spanish-language toolkits and training
  manuals
• Support Indian Health Service in distributing
  their culturally modified kits
• Collaborate with partners for distribution and
  reprinting
• Use evaluation results to modify the kit and
  training
• Utilize new types of channels worksites,
  pediatric offices, clinics, hospitals, insurance
  providers, school nurses

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• RESOURCES
• www.womenshealth.gov/bodyworks/
• www.womenshealth.gov/owh/
• www.womenshealth.gov/quickhealthdata/
• www.girlshealth.gov

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• CAPT Susanne Pickering
• Regional Womens Health Coordinator, Region IV
• 61 Forsyth Street, SW Suite 5B95
• Atlanta, GA 30303
• 404-562-7904 Fax [phone]
• Susanne.Pickering_at_hhs.gov

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• Contact  
• Jonelle, Rowe, MD
• Office on Womens Health
• jonelle.rowe_at_hhs.gov
• 202-205-2373 
• bodyworks_at_hagersharp.com
• 1-800-994-9662