2. WOMEN BREATHE FREE INTERVENTION Women Breathe Free is the first asthma management program specifically designed for women. It has been designed to focus on female gender-specific issues that may impact women’s asthma

3. WHY WOMEN: ASTHMA AND GENDER  More symptoms, diminished QOL  Baseline pulmonary function: Male=Female  Female sex hormones play key role in asthma development and severity for women  30% to 40% of women during menses  Coughing and breathlessness are more severe in women with menstruation-linked asthma  Increase in health care utilization in women with menses-linked asthma  1/3 of pregnant women experience a worsening of asthma  Potential for exaggerated inflammatory response during menstruation, pregnancy, the onset of menopause, and with the use of hormonal birth control

4. SELF-REGULATION Women Breathe Free is based on the theory of Self-Regulation. The theory asserts that people more likely to make long-term behavior change with personal control and investment over their own health behavior decision making.  Observation  Judgements  Reactions/Change Strategies for Improved Management  Response and Reflection P R I D E  P roblem identification  R esearch and observation  I dentify a goal  D evelop a plan  E valuate progress, establish a reward

5. CORE PROGRAM ELEMENTS 4 Telephonic/In Home or Hybrid sessions led by trained Health Educator Introduces a step-by-step self-regulation approach to help manage asthma effectively ( PRIDE ) Teaches observation skills to monitor asthma symptoms and triggers, asthma management routine, and asthma issues potentially associated with hormonal shifts and social role impact Assists patients with the development of skill sets to assimilate insight from observations into strategies for behavioral change Build patient capacity for self advocacy and increased effectiveness when communicating with clinicians and family members

6. ADAPTING FOR AFRICAN AMERICAN WOMEN Results from Women Breathe Free showed African-American women were:  Experiencing greater difficulty balancing asthma management with other life responsibilities  Less likely to use asthma medicines/attend physician visits as recommended (time and cost factors)  Reporting lower levels of family and/or social support than other women in the study  Experiencing higher rates of hospitalizations and emergency room visits than their non-African American female counterparts – largely due to inadequate access to healthcare

7. ADAPTING WOMEN BREATHE FREE FOR AFRICAN AMERICAN WOMEN WITH ASTHMA Program ElementCulture Specific Element Counseling Session Content The role of obesity in worsening asthma symptoms (BMI data – higher in AA women) Impact of family responsibilities – lack of social support Importance of community/family connections and influence on asthma management beliefs Inclusion of discussions surrounding spirituality and/or alternative remedies that may be culturally specific Participant Visuals All images used in workbook represent broad spectrum of African American women Workbook Content Culturally relevant activities discussed as potential triggers Culturally relevant examples in list of potential asthma-management problems

8. THE ACCELERATING IMPACT PROJECT (AIP) Due to a significant gap in moving proven chronic disease research findings and interventions into practice, the overarching goal of this project is to move evidence based interventions out into communities reaching the largest number of people possible; specifically, low-income families, minority groups, children, older adults, and women.

9. AIP KEY PARTNERSHIPS Planned Parenthood Mon Marte (PPMM)  Telephonic  RN’s Boston Public Health Commission (BPHC)  Hybrid  Community Health Worker  Healthy Homes Partners Asthma Center – Brigham Women’s Hospital (PAC)  Hybrid  Patient Asthma Center Coordinator (MPH/MEd)  Healthy Homes Asthma and Allergy Network (AAN)  Telephonic  Respiratory Therapists/Admin Staff/Outreach Coordinators Asthma Network of Western Michigan (ANWM)  Adapted for pediatric population  Home Based  Social workers/RN’s/Respiratory Therapist