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CHW Health Disparities Initiative

When the Heart Stops: Community Health Workers Raising Cardiovascular Disease Awareness in Public Housing, Charlotte, North Carolina

Overview

A survey conducted by the Charlotte Housing Authority (CHA) in Charlotte, NC, found that many public housing residents had risk factors for heart disease, such as high blood pressure, high cholesterol, diabetes, physical inactivity, overweight/obesity, and cigarette smoking. In 2009, the CHA partnered with the Department of Housing and Urban Development and the NHLBI to train community health workers (CHWs) to deliver heart health education in two public housing communities where a total of 680 families live, in an effort to address this health disparity.

bar graph illustrating data from forthcoming table
Percent of Public Housing Residents in Charlotte, NC with Cardiovascular Disease Risk Factors
Risk Factor Percent of Residents
High Blood Pressure 46.6
High Blood Cholesterol 23.3
Physical Activity 11.0
Obesity 31.5
Diabetes 16.0
Cigarette Smoking 3.2

Program Goals

There were three goals involved in implementing the With Every Heartbeat Is Life (WEHL):

  • Bring awareness of risk factors for heart disease.
  • Promote healthier food choices and preparation.
  • Encourage socializing to share lifestyle changes.

Implementation Strategies

The CHA chose residents who were active in the community and involved in other organizations to serve as CHWs. The CHA trained the CHWs to use the NHLBI’s WEHL manual to teach about heart disease, its risk factors, and ways to make heart healthy choices. In addition to teaching courses, CHWs helped participants

  • Find a primary care doctor or a medical home system,
  • Schedule health care appointments, and
  • Take advantage of sliding-fee schedules offered to uninsured individuals by the local health center.

The CHA offered child care during the class sessions, and CHWs taught a portion of the WEHL manual to the children. At the end of the program, the children performed a health-related skit for the graduates. At the end of each session, participants sampled a recommended heart healthy snack or meal.

Target Audience

African Americans living in or near public housing communities.

Recruitment

To recruit class participants, the CHA promoted the 10-week heart health With Every Heartbeat Is Life program at community events and with fliers. CHA offered $100 to each person who successfully completed the whole course, and prorated amounts for those who completed at least 8 out of 10 sessions (e.g., $90 for nine weeks, $80 for eight weeks). Participants who did not complete at least 8 sessions did not receive an incentive.

Partnerships

The CHA partnered with a local community health clinic, the C.W. Williams Community Health Center, to identify and monitor heart disease risk factors such as overweight/obesity, high blood pressure, and high blood glucose levels. If a WEHL class participant had elevated risk factors, that person was referred to C.W. Williams for health services. The CHA partnered with the city’s Department of Social Services to inform participants about WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) eligibility and using WIC resources to buy healthy food. A local home improvement store donated $1,700 in supplies to start a garden. Class participants tended the garden and benefited from the harvest.

CHWs brought in fitness instructors to lead exercises and demonstrate exercises that participants could do at home. Several participants formed walking or fitness groups within their communities. The CHA created an interactive video system bowling league, which not only was a fun workout but also encouraged people with disabilities or physical limitations to exercise.

The CHA also held a weight-loss challenge during the program. Each week, the participants in the weight-loss challenge made a pledge, such as cutting down on salt or sugary snacks or getting more exercise, and received a small reward the next week for sticking to their pledges. Participants who lost the most weight by the end of the program earned bigger rewards, such as an indoor grill. Everyone who took part in the weight loss challenge reported losing at least 12 pounds and lowered their risk factors for heart disease.

Key Results/Outcomes

Given the success of the program, the CHA now has a waiting list of candidates for the CHW training program and another for residents who want to take the classes. Some residents even take the classes without the financial incentive because they enjoy the social aspect. The CHA’s health fairs are also a draw for residents.

  • About 100 people attended each of the three health fairs.
  • Through the CHA’s partnership with the local health clinic, at least 10 WEHL participants were referred to medical homes.
  • Since June 2009, 150 residents have completed the health education program, which has been offered seven times, and the CHA has trained 15 CHWs.
  • Several CHWs have gone on to careers or training in health care. For example, some CHWs found employment as nurses’ aides or working at a youth program connecting teen mothers with local resources for assistance. One CHW took courses to become a medical billing specialist. Others have started training to become registered nurses or licensed practical nurses.

Lessons Learned

The results of the community needs assessment demonstrated that this community was in need of education about cardiovascular disease risk factors. The CHA was able to train CHWs to implement the WEHL curriculum to elicit positive heart healthy changes in residents.

The CHA program has succeeded because of four key strategies:

  • Identify well-connected people in the neighborhood. The CHA continues to recruit more CHWs from WEHL participants.
  • Take advantage of diverse partnering opportunities. The CHA sponsored several health fairs to reach local residents. The health fairs featured representatives from pharmacies, grocery stores, fitness and recreation centers, farmers’ markets, and the local health department. Local choirs performed for entertainment.
  • Get ideas from residents and encourage CHWs to be creative. The enthusiasm and engagement of CHWs and participants made the classes and activities fun. The CHWs planned group activities, such as a class field trip to a local store, to make the heart health education program more engaging. Before the field trip, the participants planned a menu, made a grocery list, and read food labels as they shopped to better understand how their menus stacked up in terms of nutrition.
  • Provide incentives and rewards, both large and small. Even small token prizes can be motivating.

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Last Updated: June 2014