Identifying obesity as one of the triggers for hypertension and diabetes in African American women, a group of community and faith leaders working with the research team developed a faith-based initiative called Women of Wonder. The intervention was conducted in a local church using the minister and other volunteers. The project provided women with health education, blood pressure testing, weight measurement, nutritional support, group support, and counseling. Over the 26 weeks of the project the participants were able to reduce blood pressure and weight and sustain the losses for an additional 52 weeks through long-term life style changes.
This success led to other projects that attempted to delineate factors for success. Several projects developed around chronic disease self- management used peer coaches to create patient engagement. In each of these peer coaches were trained using a classroom model. They were then sent into homes to assist others with the same health care issues to help them improve their health status. Although effective in reducing hospital and emergency room utilization the level of patient engagement was not present in the peer mentor models.
More recently the team and community has been addressing the issue of health literacy after recognizing that an ongoing barrier to health care remains the issue of understanding and participating in care decisions. Current interventions include use of materials that are developed after ethnographic research is conducted to understand patient meaning and issues. Then from this framework materials are developed to meet the needs of the patient and provide information that they find useful. Tools developed using this format have had widespread success in a number of settings in reducing costs of health care, readmission rates, emergency room utilization, and patient satisfaction. Recent literature suggests that engaging patients in the care delivery process through health literacy may reduce or eliminate some of the social barriers to health care.