U.S. Department of Health and Human Services
Health Resources and
Services Administration
BFWHW Administrator's Handbook: Training And Implementation of BFWHW Physical Activity and Healthy Eating Guides
ABOUT BFWHW & THE GUIDES: The Bright Futures for Women’s Health and Wellness (BFWHW) initiative is a project of the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA), Office of Women’s Health.
CONTENTS: This Handbook describes the My Bright Future Physical Activity and Healthy Eating Guides and other patient and provider materials.
IMPLEMENTING AND USING THE BFWHW MATERIALS: The BFWHW Guides and companion materials will help you address physical activity and healthy eating with female patients.
RECOMMENDED PROTOCOL FOR USING THE GUIDES AND MATERIALS: A diagram and step-by-step descriptins show how the BFWHW Guides and materials may be used in the clinical setting.
FOR THE ADMINISTRATOR:Tips for Setting Up the Bright Futures Training
FOR THE TRAINER: Tips for Implementing the Bright Futures Training
ADDITIONAL INFORMATION AND MATERIALS: For questions and/or more information about implementation of these materials
The Bright Futures for Women’s Health and Wellness (BFWHW) initiative is a project of the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA), Office of Women’s Health. The mission of BFWHW is to plan, develop, implement, and evaluate a variety of culturally competent consumer, provider, and community-based products for all women across their lifespan—including underserved and minority women. The Bright Futures materials help to promote women’s physical, emotional, social, and spiritual health and well-being.
About the BFWHW Physical Activity and Healthy Eating Guides
Patients look to their health care providers for information about physical activity and healthy eating. Helping patients improve these behavioral patterns can lead to better health outcomes, such as decreased overweight/obesity, and lower health care costs.
The My Bright Future: Physical Activity and Healthy Eating Guides for Young Women (adolescents) and Adult Women enable providers to:
- Quickly and easily assess their patients’ physical activity and healthy eating behaviors.
- Make recommendations for improvements.
- Help patients set goals.
- Direct patients to more information.
This Handbook provides information on BFWHW physical activity and healthy eating materials for patients and providers. It also contains information on how to:
- Train staff to use these materials.
- Implement them within the clinic setting.
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HRSA pilot tested the Guide for Adult Women with administrators, health care providers, and more than 900 female patients at several HRSA-funded health clinics, including one that served a predominantly Latina population. The Guide tested well. Several important findings resulted from the pilot test:
- Using the Guide added only a few minutes to patient visits.
- The Guide worked well across the lifespan and racial and ethnic groups.
- The Guide greatly enhanced or facilitated patient-provider discussions on physical activity and healthy eating.
- The Guide was easy for most women to read.
The patient Guides are written at a 6th-grade reading level and are easy for most women to read. |
HRSA also pretested the Guide for Young Women and companion wallet card among 26, 11- to 20-year-old females in Baltimore, Maryland. Again, findings from the pretest were positive and indicated that the young women:
- Liked the language and format of the Guide and wallet card.
- Would use the Guide as a first step in talking to health care providers about physical activity and healthy eating.
- Would use the Guide to help them make decisions about healthier eating choices.
This Handbook describes the My Bright Future Physical Activity and Healthy Eating Guides and other patient and provider materials. It also contains information on how to train health care providers to implement the Guides in the clinical setting, using a PowerPoint presentation. Specifically you will find:
FOR ADMINISTRATORS
Administrator’s Handbook
- Introduces the Guides and other companion materials.
- Shows how the Guides and other materials fit into the health care visit and flow of the clinic.
- Gives ideas on how to implement the Guides in the clinical setting and how providers may use them.
- Provides tips for setting up a staff PowerPoint training session on the materials.
FOR TRAINERS
Trainer’s Section of Administrator’s Handbook
- Introduces trainers to the Guides and how the materials fit into the health care visit.
- Provides tips for customizing the training session.
All materials for patients and health care providers are available to download from HRSA at www.hrsa.gov/womenshealth. Materials for patients only may also be ordered free of charge from the HRSA Information Center at 1-888-ASK-HRSA or http://www.ask.hrsa.gov. |
FOR PATIENTS AND PROVIDERS
Young female patients (age 11–20) answer questions in the Guide on their own during the health care visit. Then they review their responses with the health care provider.
- The Guide helps patients:
- Identify current levels of physical activity and healthy eating behaviors.
- Talk with providers about related issues.
- Set goals to improve or change behaviors, as recommended by the provider.
- Learn basic information to get started on reaching goals.
- Providers complete pages related to “My Health Care Visit” and “Setting My Goals” with patients.
Wallet Card for Young Women
- The take-home reference piece reinforces key messages contained in the Guide.
- Patients can keep the card in their purse or another convenient place and use it as a handy reference.
Guide for Adult Women
- Similar to the Guide for Young Women, this Guide is targeted at adult female patients age 21 and older.
- Providers complete pages related to “My Health Care Visit” and “Setting My Goals” with patients.
Adult “Reaching My Goal” Tip Sheets
- One-page sheets expand on key topics in the adult Guide by offering:
- Tips for reaching specific goals.
- Activities to try.
- Testimonials from women who have met similar health challenges.
- Based on the goals set, the provider recommends the relevant tip sheet(s) for the patient to take home.
FOR PROVIDERS
Counseling Support Tool
- The reference helps providers to make recommendations based on the patient’s answers in the Guides.
- Links unhealthy answers (e.g., eating fruit only once a day) to information that providers can give patients:
- Provides Federal health guidelines (e.g., eat at least 1 ½ - 2 cups of fruit daily).
- Recommends behavioral improvements or changes (e.g., eat more fruits, drink 100% fruit juice)
CDC Chart: Body Mass Index-for-Age Percentiles for Young Women
The BFWHW Guides and companion materials will help you address physical activity and healthy eating with female patients. They will also help providers and patients to initiate discussions and goal setting about these topics. By implementing the Guides, you will help your patients to live healthier lifestyles and reduce their risks of chronic diseases, such as high blood pressure and diabetes. The Guides and materials also benefit your clinical setting by:
- Enhancing the well-care benefits offered.
- Improving patient-provider relationships.
Some key steps to implementing the materials are:
- Get buy-in—Introduce the BFWHW materials to the medical director and key staff and reach a decision on implementation. Discuss challenges, opportunities, and staff suggestions on incorporating the materials.
- Implement according to clinical needs—Although this section recommends ways to incorporate materials into the clinical flow, you know what works best in your health care setting. Adapt this set of materials to your clinical needs and/or practices. You will need to determine whether you will use both the adult and adolescent Guides, versus only one, and what types of health care visits will be best for this kind of Guide. During the pilot-testing, one of the sites used the Guides with patients who were only coming in for annual checkups or well-care visits.
- Train staff—Train everyone who will implement the materials to ensure that the Guides are used seamlessly in the clinical flow.
- Determine the best place to store materials—HRSA recommends having the front office staff hand out the materials to the patients. Therefore, the Guides, wallet cards, and “Reaching My Goal” Tip Sheets should be conveniently stored and available to front office staff. Alternatively, the tip sheets could be kept in exam rooms for providers to distribute to patients during the goal setting activity.
- Set an official start date—This will ensure that all staff know when to start using the materials and that all steps are carried out according to the clinic’s protocol from the beginning.
- Use consistently—Once you’ve identified which materials you will use, it is very important that they be used consistently. Make sure that all of the patients receive the Guides and that all providers review them with their patients. These Guides are designed for young women and adult women, regardless of weight and body size.
The diagram below illustrates how the BFWHW Guides and materials may be used in the clinical setting. A more detailed step-by-step description of the process follows the chart.
[Graphic of diagram showing how the BFWHW Guides and materials may be used in the clinical setting]
Step 1: Front Desk:
- Front desk staff gives patient the age-appropriate Guide. Young women are also given a wallet card. The staff person asks the patient to read through the Guide and complete the “Getting Started” and “Talking With Your Health Care Provider” sections at the beginning of the Guide before seeing the provider.
Step 2: Waiting Area:
- The patient answers the physical activity and healthy eating questions and completes the “Talking With Your Health Care Provider” section.
Step 3: Clinical Area:
- Staff checks and records height, weight, body mass index (BMI), blood pressure, and other measurements, which are noted in the Guides.
Step 4: Exam Room With Provider:
- If not done previously, the provider calculates the patient’s BMI and records it in the Guide. (To determine BMI for adult women, the provider uses the BMI chart in the adult Guide.
- For young women, calculation of BMI-for-Age Percentiles is a 2-step process – first the provider calculates the BMI and then the BMI is plotted to figure out the BMI-for-Age Percentiles. A CDC chart is available at:
http://www.cdc.gov/nchs/data/nhanes/growthcharts/set3/chart%2016.pdf to assist providers with the calculation. Also, an online BMI calculator is available at: http://www.shapeup.org/oap/entry.php. Additional information on BMI for adolescents can be found on the CDC’s Web site: http://www.cdc.gov/nccdphp/dnpa/bmi/bmi-for-age.htm.).
- The provider talks with the patient about what BMI is and what her number means.
- The provider asks if the patient has any questions or concerns.
- The provider uses the Counseling Support Tool to review the patient’s responses to the questions. Based on the patient’s answers, the provider identifies areas that need change or improvement.
- The provider and patient work together to develop a plan for making improvements.
- The provider and patient use the recommendations to set goals that the patient writes down in her Guide.
- For adult women: The provider recommends specific “Reaching My Goal” Tip Sheets and notes the recommendation(s) on page 10 of the Guide.
- For young women: The provider directs the patient to relevant pages in the back of the Guide and the wallet card where she can find more information on how to get started on reaching her goals.
Step 5: Front Desk:
- Adult patient requests and collects the recommended “Reaching My Goal” Tip Sheet(s).
- Patient takes Guide home for future reference.
The administrator plays a crucial role in setting up the Bright Futures PowerPoint training so that all health care providers know how to successfully implement the Bright Futures Guides. Also, once the Guides and materials have been in use for a few weeks, it’s a good idea to discuss how they’re working at a future staff meeting or one-on-one. This will provide important feedback on the success of the implementation and on how to resolve any “kinks.” It will also allow the staff to air any concerns, questions, or issues that may have arisen.
What is the administrator’s role?
- Decide who should conduct the training.
- Set a date and time for the training.
- Notify health care providers and other staff when the training will occur and request confirmation of attendance.
- Organize the training and make sure equipment and materials are available.
Who should conduct the training?
The training should be given by a senior staff member who is comfortable with group presentations. This may be the:
- Clinic administrator.
- Health educator.
- Medical director.
- Nurse manager.
- Other health care practitioner.
When should the training be scheduled?
A group training should be held when most health care providers are available, perhaps during regularly scheduled staff meetings, lunchtime, or nonclinic hours. Group trainings are recommended since they will facilitate idea sharing and discussion about the materials.
How long will the training be?
The training will last approximately 1–1½ hours, depending on the number of PowerPoint modules that are discussed. If necessary, the training can be divided into two sessions prior to the implementation of the Guides. For more information, see “For the Trainer: Tips for Implementing the Bright Futures Training.”
What equipment and materials are needed for the training?
This checklist will help you to prepare for the training and may be modified as necessary:
- PowerPoint presentation downloaded from HRSA at www.hrsa.gov/womenshealth and copied to a laptop computer.
- Laptop computer and LCD projector/screen for displaying the PowerPoint presentation.
- Copies of PowerPoint handouts for participants.
- Copy of PowerPoint speaker’s notes for the trainer.
- Guides for Adult Women and “Reaching My Goal” Tip Sheets for participants (if implementing the Guide for Adult Women).
- Guides for Young Women and wallet cards for participants (if implementing the Guide for Young Women).
- Counseling Support Tools for participants.
- Poster paper, markers, and/or easel.
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Training all health care providers on how to use the Bright Futures Guides is essential for successful implementation.
The trainer’s role
- Become familiar with the Guides and companion materials.
- Conduct the training using PowerPoint modules.
- Answer questions from staff.
- Serve as a staff resource as the materials are implemented.
Customizing the presentation
The PowerPoint presentations consist of the following five modules:
- Module 1: Introduction—Overview and benefits of the Bright Futures Guides (15–20 minutes).
- Module 2: Materials for Young Women—Step-by-step review of the Guide and wallet card, including tips on the sections that providers complete (30 minutes).
- Module 3: Materials for Adult Women—Step-by-step review of the Guide and Tip Sheets, including tips on the sections that providers complete (30 minutes).
- Module 4: Materials for Adult and Young Women (for clinics that implement both Guides for Adult and Young Women)—Step-by-step review of the adult materials and a brief discussion of how these materials differ from the materials for young women (40 minutes).
- Module 5: Goal Setting and Counseling—Guidance on setting goals with patients and effective communication (20 minutes).
Keep in mind that you only need to train on three modules, as follows:
- If implementing materials for young women, present Modules 1, 2, and 5.
- If implementing materials for adult women, present Modules 1, 3, and 5.
- If implementing materials for both young women and adult women, present Modules 1, 4, and 5.
It is recommended that all three modules be presented during one session, which should take approximately 1–1½ hours in a group session. However, if necessary, Module 5 may be presented during another training session prior to implementation of the Guides. The decision to present one or two sessions should be made ahead of time with the administrator.
Preparing for training
To facilitate training, scripts are provided with each PowerPoint slide in the speaker’s “Notes” section. These scripts can be adapted as needed.
Once you’ve reviewed this handbook:
- Make sure you have the following materials along with the slides and notes:
- PowerPoint presentation downloaded to a laptop computer.
- Guide for Young Women.
- Wallet card.
- Guide for Adult Women and “Reaching My Goal” Tip Sheets.
- Counseling Support Tool.
- Review the slides, notes, and materials.
Refer to page 8 for equipment and materials that are needed for this training.
Points to emphasize throughout the training
- The BFWHW initiative provides materials for use in the patient care setting to address physical activity and healthy eating.
- The Guides were tested and worked well across the lifespan and racial/ethnic groups.
- Using the Guides adds only a few minutes to patient visits and helps providers quickly determine behaviors that patients need to change or improve.
- Patient-provider interaction and patient satisfaction can be enhanced as a result of using the Guides.
- The Guides are written at a 6th-grade level and are easy for most women to read.
During the training, encourage discussions about the Guides and implementation ideas, and answer questions from the staff.
After the training
After the materials have been used for a few weeks, ask the administrator to schedule a follow-up session to discuss how the materials are working and how to resolve any procedural issues that may have arisen.
For questions and/or more information about the implementation of these materials or to provide feedback, please contact HRSA at: comments@hrsa.gov.
To obtain copies of health care provider and patient materials, please download them from www.hrsa.gov/womenshealth. Materials for patients only may also be ordered free of charge from the HRSA Information Center at 1-888-ASK-HRSA or http://www.ask.hrsa.gov.