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 Using Life Course Theory in Evidence-based Practice: Healthy Women, Healthy Futures

By Su An Arnn Phipps PhD, RN
The University of Oklahoma College of Nursing, Project Director, Healthy Women, Healthy Futures

The Oklahoma Healthy Women, Healthy Futures (HWHF) is a one-year program based on the life course perspective to address the interconception health of women living in poverty. HWHF was developed in 2008 in conjunction with Community Action Project (CAP) Tulsa and Educare early childhood education programs (ECE) to address the health equity of mothers whose children attend the ECE centers. Both Educare and CAP Tulsa have innovative family financial, education and neighborhood initiatives. HWHF is offered at six ECEs located in diverse geographic areas of Tulsa County experiencing the highest mortality and premature birth rates. Approximately 100 women attend the program annually.

Life course theory addresses the importance of early programming to one’s future health and development through both intergenerational programming (a woman’s preconception health) and prenatal programming (in utero). Life course considers the cumulative impact of life experiences, including multiple stresses over time that many women and families living in poverty experience. HWHF attempts to reduce such risk factors, which diminish health, and improve protective factors by improving women’s access to primary care and other health services and through health education and care coordination.

The HWHF goals are to improve maternal health and infant birth outcomes by:

  1. Improving women’s knowledge of health promotion measures and disease prevention practices. Weekly hour and a half culturally relevant health education classes are taught on site at the ECEs by the nurse educators, who also provide individualized instruction at home for those with chronic illnesses. In addition to disease prevention, nutrition and exercise, the curriculum addresses the possible contextual risks of participants, such as stress, family conflict, domestic violence, and depression. Women learn the importance of intergenerational and prenatal programming on their health and that of current and future family members.
  2. Assisting women to improve their health through development of a health plan, which incorporates healthy lifestyle practices and a reproductive life plan, and by facilitating access to services. Each participant is a member of a care coordinator and nurse educator team. Admission assessments and plans of care are developed by the HWHF staff and participant team during home visits, and reassessments are conducted at the end of each semester with participants serving as their own "controls" to determine changes in lifestyles, knowledge and health. Qualitative data (participant feedback) gathered at these times reflect changes in the health and health practices of children and other family members as a result of women applying new knowledge to family health.

Evaluation data has shown that HWHF leads to health improvements related to improved knowledge and resultant behavior change; lifestyle improvements, such as increased exercise and better nutrition; and healthy pregnancy outcomes among participants despite 30 percent of pregnancies being moderate to high risk. Of the 41 pregnancies, 37 have resulted in term births with four late preterm births (34-36+ weeks gestation). All infants were at average weight for gestational age. Participants frequently report that their current pregnancy was different or better than their previous pregnancies. As women’s knowledge of health and wellness grows, they become empowered to change their own behavioral patterns and practices throughout their life, and influence the lives of family members and future generations as well.

For more information about HWHF, visit hwhf.ouhsc. edu. Funding is provided by the George Kaiser Family Foundation.

Healthy Women, Healthy Futures is listed as a Promising Practice in the AMCHP Innovation Station database. For more information, visit