Evaluating the Impact of Wellness Days on Enrollment of Underserved Women in the Connecticut Early Detection and Prevention Program

Assessment of Need

Despite national attention to health disparities, socioeconomically disadvantaged and minority populations remain at increased risk of cardiovascular disease and cancer due to gaps in translation of appropriate interventions (Purnell et al., 2016). Common challenges to breast and cervical cancer screening include both structural barriers (e.g., transportation and cost) and personal barriers (e.g., lack of knowledge and fear; Barrington et al., 2019). Interventions involving patient navigators and community health workers are increasingly recognized as effective ways to address these barriers (Roland et al., 2017; Shokar et al., 2019). Community health fairs are another common strategy to reaching the underserved because they provide venues for patient education and accessible screening services (Murray et al., 2014). The Connecticut Department of Public Health (CTDPH) has established an integrated approach utilizing these strategies to provide preventive services to underserved women across the state.

Description of Strategy

The CTDPH is a grantee of two national chronic disease prevention programs through the Centers for Disease Control and Prevention: The Connecticut Breast and Cervical Cancer Early Detection Program (CBCCEDP) and the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) Program. The CBCCEDP was initiated in 1995 and provides breast and cervical cancer screening and diagnostic services to underserved women. The WISEWOMAN Program focuses on heart disease prevention by promoting healthy lifestyle behaviors. These programs share a common goal of reducing health disparities by serving a priority population of uninsured and underinsured women. Given the overlap in objectives, resources utilized, and populations served, the CTDPH identified an opportunity to combine CBCCEDP and WISEWOMAN to streamline efforts. In 2015, the programs were integrated to form the Connecticut Early Detection and Prevention Program (CEDPP), allowing women to receive more comprehensive care.

The CEDPP utilizes a team-based navigation model of care to promote screening and diagnostic services. Each CEDPP contractor has a Navigation Team that includes a Community Health Worker (CHW), Health Systems Navigator, and Clinical Navigator, who work together to deliver patient-centered care. The Navigation Team is responsible for implementing Wellness Days in the community. Similar to community health fairs, Wellness Days provide education, health assessments, screening tests, and clinical referrals in settings that are more familiar and convenient for intended populations. Wellness Days take place in various locations, such as public venues, community clinics, or mobile health units. CEDPP contractors collaborate with community partners that implement similar events such as Walmart, Physicians for Women, Black Nurses Association, and faith-based organizations.

Evaluation Approach and Preliminary Findings

Working with an external evaluator, CEDPP developed a strategic evaluation plan to measure their implementation efforts across programs. To standardize data collection, CEDPP established a tracking tool and checklist for contractors to complete following each Wellness Day event. The checklist includes the protocol on how to prepare, implement, and evaluate each Wellness Day. The tracking tool includes fields on services provided, number of women reached, number of women enrolled in the program, and areas for improvement. CEDPP also uses a data management system to collect information on referral source and number of women screened through the program. CEDPP staff trained CHWs on how to document this information to ensure data quality and accuracy. Lastly, as part of the evaluation, facilitated discussions were held with contractors to learn about successes and challenges with implementing Wellness Days.

Process measures used to assess this approach include number of Wellness Days, services offered at each event, and number of women reached. The primary outcome measure is the number of women enrolled in the program due to participation in a Wellness Day event. Successful program enrollment includes patient education, cardiovascular screening (measurements for blood pressure, height, weight, glucose and cholesterol), and scheduling an appointment for breast and cervical cancer screening.

In 2019, CEDPP contractors conducted 47 Wellness Days, reaching 2,509 women across Connecticut. The most common service type provided at Wellness Days was patient education (87.2%), followed by clinical referrals (38.3%) and health assessments (25.5%). Only 10.6% of Wellness Days offered mammograms and 6.4% offered Pap tests. Among women reached, 107 (4.3%) were successfully enrolled in the CEDPP. Table 1 provides the number of Wellness Days implemented, number of women reached and enrolled, and percentage of women ultimately enrolled by CEDPP contractor. Among all contractors, Contractor B had the greatest success with enrolling women at 35.6% of those engaged. This finding may be due to the contractor’s strict adherence to the checklist when compared with the other contractors.

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Table 1

Wellness Days Reach and Enrollment by Contractor

Contractor	Number of Wellness Days	Number of Women Reached	Number of Women Enrolled	Percentage of Women Enrolled
A	8	292	20	6.8%
B	5	188	67	35.6%
C	3	380	0	0.0%
D	15	804	8	1.0%
E	6	195	10	5.1%
F	10	650	2	0.3%
Total	47	2,509	107	4.3%

Lessons Learned and Next Steps

Based on the initial evaluation findings, CEDPP recognized opportunities to increase program enrollment through Wellness Days. Areas for improvement include having participants complete the program application on-site as opposed to on their own time, increasing the number of Wellness Days that offer on-site comprehensive screening services, improving community promotion efforts, ensuring that educational materials are multilingual, and better identifying venues that reach the intended population. Expanding the scope of Wellness Days to include resources on diet, medication management, and mental health would also further enhance the program. Finally, CHW training on data collection was identified as an opportunity to improve evaluation efforts.

Implications for Practice

Community health fairs are an avenue to provide preventive health services and education to medically underserved populations in a more accessible setting than traditional clinical sites. Health fair participants seek these opportunities to address wide-ranging health concerns (Murray et al., 2014). By combining two major chronic disease prevention programs, the CEDPP is able to meet this need by offering comprehensive services to socioeconomically disadvantaged women through the implementation of Wellness Days. With the enactment of identified areas for improvement and continuation of robust evaluation efforts, the CEDPP anticipates enhancing its impact on women’s health across Connecticut. Furthermore, Wellness Days can be used as a vehicle for prevention and screening services for a variety of health issues. Working in collaboration across chronic disease areas and pooling resources can expand care for those in greatest need.