Women of Skid Row

- Women for Wellness Program -

The Women for Wellness program was hosted at the Downtown Women’s Center, a community-based non-profit organization providing housing and supportive services to adult women experiencing poverty and homelessness. Based on the Diabetes Prevention Program (DPP) model, the program provided weekly group classes and individual coaching to monitor food and activity goals, blood pressure, Body Mass Index, and A1c levels. The facilitator was trained as a Lifestyle Coach for DPP, an evidence-based program funded by the National Institutes of Health and supported by the Centers for Disease Control and Prevention.

DPP was adapted to this population in order to address their unique barriers – such as lack of affordable housing, financial stress, lack of affordable and nutritious foods, and safe places to exercise. Fifty women voluntarily enrolled in the Women for Wellness Program for one year.

During the classes, participants were informed about the health and social services at the Downtown Women’s Center to encourage access when needed. Available services include housing, daily meals, case management, showers, and bathrooms. Additional health programming at the Downtown Women’s Center included medical case management, health education classes, nutritional counseling, chronic disease self-management support groups, peer support, fitness classes, and other health screenings. Participants who were patients at the co-located Women’s Health Center, a Federally Qualified Health Center (FQHC) and satellite site of the Wesley Health Centers, were also encouraged to meet with the Primary Care Physician.

In order to increase program retention and outcomes reporting, incremental incentives were delivered based on attendance and class participation. These included gift cards to local grocery stores, blood pressure monitors, kitchen and household items, exercise equipment, and clothing.

Women completed a risk assessment survey in order to determine program eligibility. Women ages 18 and above who met criteria for being at risk or currently diagnosed with pre-diabetes or diabetes were eligible for this study. Participants monitored blood pressure and BMI monthly at minimum. Participants with A1c tests monitored their levels every six months. As a part of the DPP model, participants were asked to complete food tracking records to monitor daily calorie and fat intake. Participants were also encouraged to exercise regularly and set weekly personal health goals.

Due to requests by the program participants for additional information on nutrition, the program also focused on healthy food access and skill-building exercises to increase efficacy in food preparation and cooking while factoring in their limited budgets. For many of the sessions, one of the program participants volunteered to lead in order to share her expertise as a nutritional chef. Her weekly food demonstrations used healthy recipes modified for diabetics, with affordable and accessible ingredients amenable to the homeless and low-income population.

For participants with limited education, curriculum was also modified to best fit their literacy and reading comprehension levels. For example, the facilitator provided additional materials and translators for monolingual Spanish-speakers that were more culturally appropriate.

Women for Wellness Program Results

Attendance fluctuated by month, but generally remained consistent throughout the year. If participants missed group sessions, they were able to meet with the Lifestyle Coach in order to make-up the session. Phone sessions were also allowed if participants could not attend in-person sessions due to major health or housing concerns such as temporary hospitalizations.

As measured by the 100 Million Healthier Lives Well-Being Survey, after 6-months, women perceived a 44% increase in ‘Healthier Lives’ and by the end of the year, they described an 84% increase in ‘Healthier Lives’. The Women for Wellness program achieved an 84% increase in ‘Healthier Lives’ by the end of the year, indicating that the participants’ overall sense of well-being had improved since the beginning of the program. As social support and female empowerment themes were incorporated into the program, participants may have developed stronger relational bonds with each other and the facilitators throughout the program, increasing well-being indicators.

Out of the 50 participants in the one-year program, 48% improved Body Mass Index totals from baseline and 92% improved Blood Pressure from baseline. Out of the 34 participants who completed the A1c screening tests, 44% reported an improvement from baseline. The percentage of overweight individuals decreased from 28% at baseline to 26% at the end of the program. The percentage of obese individuals increased from 50% at baseline to 56% at the end of the program. During this program, the percentage of participants who were permanently housed increased from 32% to 44%.

The program also provided instruction for blood pressure monitoring, which may have increased participants’ self-efficacy for self-monitoring behaviors. A slight decrease in overweight percentages and an increase in obese percentages suggest that the program was not as effective in weight management outcomes.

Being a part of this diabetes program has changed my life! I learned that even if we can't afford a lot of foods out there, we can still find ways to eat healthier. I am so glad this program was available to us for free. I learned so many new recipes that are affordable and easy! I can't wait to try them on my own.
I loved this program. Even when I gained weight from the last weigh-in, I was still encouraged to keep trying. This program is about us women learning how to take care of ourselves. To love ourselves first. And that means taking the time to make sure we are eating well and exercising.
I have met other women in the classes who understand where I have been. Managing my diabetes while being homeless is so challenging, but coming to this class encouraged me that there are people out there that care. And they want to help us get healthy.

- Women for Wellness Program Participants