The March of Dimes is proud of the all the Tennessee babies served through the Community Voice program since it opened in August 2007.  Due to the current economic climate, the State of Tennessee had no choice but to cut funding and the project will end on June 30, 2010.

We would like to thank the GOCCC (Governor’s Office of Children’s Care Coordination) and CROW (Center for Research on Women) for all the dedication and hard work on the Community Voice project. 

As the economy improves, we hope there will be future opportunities to reinstate elements of the program.   

Overview

In its ongoing efforts to improve the health of babies, the March of Dimes funded and implemented the Community Voice program in Lynchburg, Virginia to provide information to African-American families through their existing community networks.  Community Voice aims to raise community awareness and encourage community action around preconception care, premature birth, preterm labor and infant safety in order to reduce disparities and improve birth outcomes.  The Community Voice program aims to support behaviors that promote healthy pregnancies -- motivating people to encourage lifestyle changes.  The curriculum is based on the health belief model and thus focuses on a persons’ perception of the threat of a health problem and the behavior(s) for preventing or managing the problem.  It emphasizes the benefits of action, the consequences of unhealthy decisions, barriers to action, cues to action and self-efficacy or empowerment (my personal action will have an impact).
 
The central component of the project is community-based trainings of lay health advisors who reach out to women (typically, 3-5 individuals) in their personal network to provide information and improve their ability to access resources. 

Program Objectives

• Increase awareness and knowledge regarding the importance of healthy nutrition practices (including folic acid intake), early prenatal care, avoiding alcohol, drugs, and tobacco (including assistance programs), and infant care practices. 

• To address infant mortality rates among the African American community in the high-risk areas and surrounding communities and maintain contacts over time.

Tennessee

In Tennessee, Dr. Kim Wyche-Etheridge, then the director of MCH for the Nashville Metro Health Department, submitted to and received a grant from the March of Dimes Tennessee Chapter Grants program to implement Community Voices.  She introduced the project to the community where March of Dimes volunteers from Memphis were in attendance. They enthusiastically took the information back to Memphis and held a Town Hall meeting in the Douglas community attended by the Commissioner of Health and the Shelby County Mayor.  Volunteers visited 30 churches for the purpose of garnering support and recruiting volunteers for the project. St. Paul Douglas Missionary Baptist Church is currently implementing the program in the Douglas community where the infant mortality rate is disproportionately high.  This project is now slated for expansion this Fall of 2007 to a 4 year 1.5 million implementation funded as an external program grant to the March of Dimes by the State of Tennessee.

The Memphis Community Voice Project launched on February 26, 2008, the project has trained over 300 people and its goal for 2009 is more than 400 individuals.  The Community Voice Project continues to raise community awareness and encourage community action around preconception care, premature birth, preterm labor and infant safety in order to reduce disparities and improve birth outcomes.  The Community Voice program supports behaviors that promote healthy pregnancies -- motivating people to encourage lifestyle changes. 

The project provides funds to support 4 staff in Memphis (a project director, two outreach specialists, and one support person). 

Additional Information about the beginnings of the first Community Voice Project - Virginia Implementation

There have been two implementations of the Community Voice project in Virginia: the first in Lynchburg, a 3-year MIOP grant from 2000-2003; the second in Martinsville, a chapter grant from July 2005 through December 2006.  Evaluation of the first Virginia implementation included pre- and post- self-reported questionnaires, community surveys (conducted via telephone) and analysis of changes in birth outcomes data (FIMR) for the intervention communities before and after implementation.  These findings suggest that the program increased community awareness, increased knowledge among those trained as lay health advisors and decreased infant mortality.  This implementation of the Community Voice project was presented during the American Public Health Association meeting in 2004.

Program Evaluation of the Martinsville Implementation: Highlights

Evaluations have been conducted on both Virginia implementations.  The most recent evaluation data from a December 2006 evaluation of the Martinsville implementation are reported here.  A total of sixty-eight (58 females and 10 males) participated as Lay Health Advisors in the Community Voice project.  Further, fifty individuals from the community were contacted to answer questions about the Community Voice project.

Pre- and Post-Test Data
An identical pre- and post-test of 16 multiple-choice questions, 19 true and false questions and six fill-ins was used to test knowledge.  Prior to instruction, the percentage of correct responses on the knowledge test ranged from 15% to 68% and the average pre-test score was 44%.  Following instruction, the percentage of correct responses ranged from 73% to 100% and the average post-test score was 92%.

Program Process Data
The number of lay health advisors actively conducting outreach ranged from 12 in the first months of the project to 52 in the final month.  In the final four months of the project, the total number of contacts made by Lay Health Advisors ranged from 128 to 141 contacts.  There was a grant total for 2005-2006 of 1869 contacts.

All of the lay health advisors trained graduated and became lay health advisors.  100% of participants stated that: (1) they learned a great deal about perinatal health; (2) they felt the training prepared them to fulfill their role; (3) they would return for a follow-up training; and (4) that the training was interesting and useful.

Community Opinion and Awareness of the Community Voice Project

In addition to outreach by lay health advisors, the project raised awareness through media that included: newspaper, newsletter, radio, television and fact sheets distributed at churches.  To assess the impact of this outreach, a survey was conducted of a random sample of community members (N=41 82% participation rate).  68% of those surveyed had heard of the project.  Television was the most commonly reported source of information (88%) followed by the newspaper (76%), radio (59%), church (56%) and newsletter (12%).