For nearly 20 years, the Jackson Heart Study (JHS) has led research to understand why African Americans are disproportionately affected by cardiovascular diseases such as high blood pressure, heart failure, and stroke. It is the largest such investigation in the United States, involving more than 5,300 black men and women in Jackson, Mississippi. Over the decades researchers have gained critical insights into factors that drive this population’s high rates of disease. Some are related to genetic and environmental conditions, but others point to heart- healthy lifestyle behaviors, such as being physically active and eating a healthy diet, that researchers have long known can be improved with more awareness. It is why the JHS has centered much of its non-research work around community education and outreach activities that promote heart-healthy lifestyles. The goal: to reduce disease risk among African Americans throughout Mississippi.
One of the more innovative ways JHS is working to do this is through an NHLBI-developed heart health curriculum that community health workers can teach to educate people about disease prevention. The 12-week course is laid out in an easy-to-follow manual, With Every Heartbeat Is Life (WEHL): A Community Health Worker’s Manual on Heart Disease for African Americans, and comes complete with picture cards, take-home resources, and tips.
Recently, The Heart Truth® released an updated version of the manual, so we talked to JHS about how it has used WEHL as part of their community outreach. Their first step, they said, was making sure the WEHL teachers were properly trained.
Training the Trainers
The JHS Community Engagement Center (CEC) team, at the Mississippi State Department of Health (MSDH), first took on the task of doing that training in July 2019. The 5-day course, which attracted -24participants, was open to local community groups affiliated with JHS, including the Community Health Advisors Network, Mayoral Health Councils as well as MSDH staff from the Mississippi Delta Health Collaborative (MDHC).
"We sat in a U shape so we could all see each other," said Jacquilyn German, Community Partnership Director for the JHS CEC. “The training involves a lot of activities, such as food demonstrations and practice reading food labels. Participants commented that they really like the yogurt parfaits and the trainers were great and engaging,” she said.
Participants then formed groups, each teaching a particular curriculum topic, such as diabetes or nutrition, to the entire class. “The teach-back sessions were essential,” German said, because they allowed the participants to consider the resources they'd need to teach the sessions to the communities they serve. “For example, I'm not a dietitian and there is a session on sodium,” German said, “so I thought about bringing in experts who could share their expertise with the group."
Teaching the Community
At the end of the five days, the next step was to figure out how best to pass the information forward—through a second set of trainers. "We took what we learned and immediately designed a similar, three--day training for our grantees," said Telisha Swan, MDHC’s coordinator for WEHL. The grantees from the MDHC who participated in the training includes their Mayor’s Health Councils, churches from the Delta Alliance for Congregational Health, and the Community Health Workers from the Delta Clinical Community Health Worker Initiative. These grantees are now planning to conduct the WEHL workshop with other local community groups in the Mississippi Delta.
Incorporating the curriculum into the grantee's scope of work is a win-win for the community, said Alice Miller, a Community Outreach Manager and Community Lead at the MDHC. "We focus on hypertension prevention, and WEHL teaches about the importance of physical activity, nutrition, and smoking cessation, which all help with blood pressure," she said.
"In addition, it is relatable to African Americans,” said Kenneth Judie, another MDHC Community Outreach Manager. “For example, the program provides healthier soul food recipes..."
Watching Change Happen The community seems to be getting the message—and appreciating it, too, German said. “Participants light up when we teach them something new,” she noted. “Showing how much salt is in a teaspoon, and then showing how many teaspoons are in everyday items is an eye-opener."
And when teachers bring to life the dire effects of making heart healthy decisions, those can also be eye openers. For example, the WEHL manual shows teachers how to make a model of a clogged artery and a healthy artery using paper and clay. "We showed the models, and they couldn't believe that eating a certain way for a long time can do that to an artery!” Swan said. “Seeing what it looked like helped them make the connection."
Many participants are now spreading the word about what they’ve learned and actively recruiting friends and family members along the way. "We have individuals who have gone through the course bring others who they're close to and who have chronic health conditions," Judie said. "When we follow-up post-training, either through our grantees or directly, we ask, ‘Are you reading your labels? Are you using the recipes with lower sugar and salt?’ and many times, they are," he said. “It’s been really rewarding.”
Tips for Teaching With Every Heartbeat Is Life
MSDH staff shared their favorite tips for successfully implementing the WEHL program:
Visit www.hearttruth.gov to download the With Every Heartbeat Is Life toolkit.