Health Legacy Program: Empowering Women to Create Positive Health Changes
The department of Social Work and Community Health (SWaCH) at RUSH offers a wide range of programming to promote the health and well-being of our RUSH community. In honor of National Women’s Health Week, we’re highlighting one of these programs making a difference in the lives of Chicagoland women of color: the Health Legacy Program, also known as HLP.
HLP Facilitators Grisel Rodriguez-Morales, LCSW, and Yessenia Cervantes-Vasquez, Lead CHW, pose with their HLP cohort during their graduation ceremony.
Background
Diabetes, prediabetes, and related health conditions are a major challenge in health equity: in the United States, the prevalence of diabetes among African American and Hispanic adults is nearly twice the prevalence among white adults. Among American women, diabetes and related conditions are also disproportionately experienced by women of color.
This health disparity is the result of a combination of factors including lifestyle choices, access to and utilization of healthcare services, socioeconomic circumstances, built environment, and access to resources. Though health care providers can inform and support diabetes self-management, most diabetes management occurs outside of health care settings through health education and self-management of health behaviors related to diet and exercise.
Women can be considered the “health regulators” of their families: often, they’re the ones who makes the doctor’s appointments, do the grocery shopping, and primarily establish family health habits. The Health Legacy Program (HLP) follows the belief that empowering women to improve their own health can, in turn, improve the health of entire families.
Goal and Structure
The Health Legacy Program is an evidence-informed workshop developed by SWaCH. The program is designed to increase health activation and facilitate positive health change among African American and Latina women living in communities that historically have been impacted by disinvestment and discrimination.
Through this comprehensive lifestyle and behavioral intervention, HLP’s goal is to reduce health disparities related to diabetes and obesity. HLP groups meet for 12 sessions over 6 consecutive weeks, with sessions offered both in English and in Spanish. Sessions are held at churches, community centers, within communities of the target population, and online via Zoom. Since its initial development in 2013, the Health Legacy Program has reached close to 1,550 women.
The Health Legacy Program's curriculum has four core components:
Health education on a variety of topics including chronic conditions, financial health, action planning, healthy eating, health benefits of exercise, types of exercise, self-love, how to interact with health care professionals, and how to navigate the health care system.
Cardiovascular exercise in the last 30 minutes of each session
Support group, also known as “circle support,” which is completed in the 2nd session of each week. Circle Support encourages participants to focus on self-love while exploring lifestyle and behavior changes, identifying barriers to behavior change, exploring cultural habits, and identifying positive and negative health habits that exist in their communities and families. This time for reflection helps plant the seeds for long-term behavior change and self-care!
Hands-on meal planning and nutrition education, including education about hydration, moderation and portion control, food labels, and breaking down barriers to grocery shopping.
Group exercise
HLP includes 30 minutes of cardiovascular exercise per session, with the goal of helping participants adopt a regular exercise routine after the program ends.
Measurable Objectives
At the conclusion of each six-week cohort, participants are expected to see improved health outcomes and behaviors, including:
Decreased blood pressure
Moderate weight loss
Increased understanding of health self-management behaviors and basic food and nutrition information
Adoption of a regular exercise routine
Development of HLP over time
Since its start in 2013, the Health Legacy Program has developed and expanded its reach, materials, and breadth of topics to support participants’ overall health and wellbeing. “We’re constantly trying to figure out: what can we change? What can we do better? What can we add, what can we take out?” says HLP facilitator Daniela Mitchem, LCSW. “It’s revised pretty frequently so that we can keep up with health information and what’s happening in society.”
Though HLP now has a comprehensive curriculum and set of materials, the first cohorts of HLP used materials from previously established programs. Facilitators like Mitchem used creativity and resourcefulness to “fill in the lines,” noting which aspects worked well and which required some adjustment. Even in these early stages, though, Mitchem notes that participants were still highly engaged in the program and saw the value in having a community of other people like them. Over time, the HLP team developed a workbook and manual to add structure to the program, which helps participants follow along with the content and have a space to write and reflect as they learn. The HLP curriculum has also been expanded to include financial and spiritual health in addition to physical and mental health, and to focus on how participants can pass their legacy onto older generations in their community as well as the younger generations.
HLP was originally created with African American women as the intended audience, but HLP staff launched their first Latina HLP Cohort in 2021. Expanding the program’s audience to include Latina communities required translation of all curriculum and materials into Spanish and training Spanish-speaking facilitators. The HLP team also worked to align some of the cultural pieces of the program, such as adapting recipes and taking family structure into account. Since 2021, HLP has hosted 5 successful Latina cohorts.
Over time, the HLP team has made other adjustments to better accommodate participants and expand the reach of the program. For example, the program is now offered in different timeslots to accommodate schedules and obligations such as school pickups for participants with young children. During the early days of the COVID-19 pandemic, HLP shifted its meetings from in-person to Zoom—requiring some creativity to keep the content engaging, to maintain privacy and confidentiality within cohorts, and to adapt some of the more physical aspects of the program, such as group exercise and cooking demonstrations, to a virtual format.
In 2023, the HLP team adapted their curriculum for CHW CONNECT, a HRSA-funded training program run by the University of Illinois at Chicago Office of Community Engagement and Neighborhood Health Partnerships (UIC OCEAN-HP) for Community Health Workers (CHWs) in Chicago. This adapted curriculum, “Facilitating the Health Legacy Program,” taught CHWs the core ideas and values of HLP and discussed important skills and considerations for facilitators of health promotion programs.
Outcomes
Data taken from 8 cohorts of the Health Legacy Program shows that participants experienced positive effects on food choices and healthy eating, physical activity, and social support gains. Participants also reported a greater awareness of how to take better care of themselves, more confidence in goal setting, and a feeling of deeper commitment to follow through on goals.
Accomplishments reported by participants who completed the program, as shown in HLP’s 2021 Annual Report.
Especially during the height of the COVID-19 pandemic, participants expressed the importance of HLP’s focus on social support and encouragement. Some groups have kept in touch long after their cohort finishes the program, choosing to maintain the relationships and support each other’s healthy habits.
These improvements contribute to the overall goal of HLP: increased health activation! By empowering women to take charge of their own health and self-care, HLP creates lasting change even beyond the 6 weeks of the program. “Even though it’s only 6 weeks, I know I’ve planted seeds to continue that legacy of taking care of their health, really diving into what self-care means for them, and making time for self,” says Mitchem.
When equipped with the knowledge, skills, motivation, and community needed to achieve better health outcomes, women in the Health Legacy Program are empowered to become active decision-makers in their own health—and to pass on that legacy to their families and communities.
Curious to learn more?
Call 870-757-0202 or visit the RUSH Generations webpage to learn more about and sign up for the Health Legacy Program!