Need: To reduce risk of obesity and chronic disease in rural northwest Illinois.
Intervention: Win With Wellness (WWW) collaborates with community organizations and worksites to improve physical activity and eating behaviors and reduce weight among adults using a multi-component approach.
Results: From 2015 to 2018, the two participating counties initiated 28 Take Off Pounds Sensibly (TOPS) groups with 367 participants. In the second round of funding, WWW recruited 183 participants for 9 TOPS groups and 8 community Heart-to-Heart sites.
Residents in northwest Illinois face
increased risks of obesity and chronic disease due to
unhealthy behaviors and limited access to physical
activity opportunities and healthy foods.
In 2014, researchers at the University of
Illinois College of Medicine Rockford compared county
data to overall state data from the Illinois Behavioral
Risk Factor Surveillance System and found that residents
of Stephenson County and Carroll County showed higher
rates of diabetes, heart disease, and current smoking
than the state average. The premature age-adjusted
mortality rate was markedly higher in both counties,
In addition, these researchers found that a significant
proportion of the population in both counties was
overweight or obese. In Stephenson County, 73.5% of
adults were obese or overweight in 2014; in Carroll
County, the percentage was 72.6%.
Interventions focus on improving health behaviors to
reduce CVD risk and assessing and addressing
environmental barriers to engaging in physical activity
and healthy eating behaviors. During the three-year
project, WWW targeted a cohort of eligible adults age
30-74 to engage in community or worksite-based
interventions to address their personal CVD risk factors
identified during enrollment screenings. By leveraging
additional funding, WWW has also been able to serve
adults who do not meet eligibility criteria, including
those over age 74. With the new funding and focus, the
following interventions were added to the initial TOPS
and HH groups:
Text-4-Wellness, a texting program in which
participants can receive information and motivational
Step-4-Wellness, a physical activity monitor program
in which participants can track their daily steps
HH online sessions
Referrals to primary care and
the Illinois Tobacco Quitline
In addition, physical activity and nutrition environment
assessments were conducted and information about existing
resources were provided to residents, both in online
format and through flyers posted in the community.
The 2018 WWW partnership includes county health
departments, clinics and healthcare systems, colleges of
medicine and nursing, a United Way branch, and a school
district. Medical and nursing students gain experience in
community-based research, and WWW benefits from their
volunteer work. Since the start of this partnership,
three medical students have helped with the WWW Facebook
page and two nursing students have helped with the
Participants receive TOPS membership through the FORHP
grant. TOPS is a weight-loss support group for adults
that focuses on small changes participants can make to
their diets and activity levels. Weekly group sessions
held in community settings include private weigh-ins and
professionally prepared, informational programs featuring
up-to-date information on nutrition, exercise, and
healthy lifestyles. The program provides positive
reinforcement and motivation to adhere to food and
HH presentations are health education sessions led by
health educators for worksites and community groups.
These presentations emphasize small, practical changes
that attendees can make to reduce CVD risk. In December
online HH curriculum modules were launched; there are
currently 13 HH modules available.
Text-4-Wellness Text Messaging Program:
Participants have the option of enrolling in this
program. Enrolled participants receive three text
messages per week for 16 weeks and have the option to
re-enroll to receive additional messages at the end of
each 16-week period. Messages provide tips and motivation
to encourage healthy eating and physical activity.
Step-4-Wellness (S4W) physical activity monitor
program: Participants have the option of
enrolling in this program. Enrolled participants receive
a physical activity tracker (if they need one) and must
agree to sync their daily physical activity with both the
tracker's app and an online platform that allows for
activity tracking and the creation of physical activity
challenges. Participants are placed in three-week
"challenges" in which they receive a daily step goal.
After each three-week challenge, participants engage in a
one-week group challenge to reach larger step goals as a
Community-wide physical activity assessments have been
completed for four communities using the Town-Wide
Assessment (TWA), Program & Policy Assessment (PPA), and
Street Segment Assessment (SSA) components of the Rural
Active Living Assessment (RALA).
Physical activity maps have been created for each
town. Food environment assessments in the same
communities using the Nutritional Environment
Measures Survey in stores (NEMS-S) have been
Results from the 2015-2018 FORHP grant
WWW enrolled a total of 367 participants, 92% female and
8% male. Participants who completed one year of the
program saw significant reductions in weight (a mean
weight loss of 8.8 pounds), which translates to a
1.5-point average reduction in body mass index (BMI). In
addition, 42% of participants lost 5% of their body
weight or more.
Thirty-nine HH sessions were conducted, with 348
participants (79% female, 21% male): 72% of respondents
reported planning to make one or more changes in physical
activity, and 83% of respondents reported planning to
make one or more changes in eating habits as a result of
attending a Heart-to-Heart session.
Results from the 2018-2021 FORHP grant
Overall, 183 participants were recruited for the cohort
study. Since this program was a continuation of the
previous funding, participants from the 2015-2018 program
were brought into the new program.
WWW has 9 TOPS groups and 11 HH sites. A total of 109
participants signed up for the optional Step-4-Wellness
program and 86 participants signed up for the
The Town-Wide Assessment (TWA) and Program and Policy
Assessment (PPA) have been completed for the rural
communities of Freeport, Lena, Mount Carroll, and
Savanna. The TWA assesses 18 town characteristics
including topography, schools, and recreational
amenities. The PPA assesses 11 town-level policy and
program items that support physical activity. These two
assessments enabled the development of a comprehensive
database of the amenities and policies that promote or
limit physical activity within each town. The information
was used to create online community asset maps.
Recruitment has taken more time and effort than
anticipated, particularly due to the difficulty in
engaging local worksites to participate. Moving from
discussions about worksite wellness to actual
implementation has required more extensive planning and
ongoing relationship-building than anticipated. Barriers
have included scheduling meetings with appropriate
worksite contacts; conflicting work schedules among
employees within a worksite, which creates challenges in
finding a time when a group can meet; busy schedules
among worksite employees, which reduces their ability to
participate in the group; and competition with other
worksite wellness initiatives, such as those offered by
health insurance companies.
Because of recruitment challenges, WWW has pursued
partnerships with community-based organizations, such as
churches, and introduced the online version of HH to
reduce participation barriers.
Physical Activity Tracker Program (S4W): The
implementation of S4W introduced a number of challenges
including participants' lack of familiarity with
physical activity trackers, teaching participants how
to pair their trackers with their phones, participants'
lack of access to technology to sync their trackers,
and smart phone issues such as compatibility with
trackers and apps. This required additional staff time
to provide one-on-one support for the participants
until they were comfortable with the technology.
WWW also created a visual guide with screenshots to
provide participants with simple instructions for
syncing and troubleshooting. For participants who did
not have a smart phone or other device for syncing, or
for those with persistent challenges with syncing,
paper tracking was offered to ensure no one would be
excluded from the program.
Participant Tracking to Maintain the Cohort:
Due to the complexity of the intervention and multiple
components, participant tracking is complex and
labor-intensive. For example, participants can join
existing TOPS and HH groups at any time, so follow-up
data collection does not necessarily occur at the same
time for all participants. Additionally, while TOPS is
a participant-led program, group leaders do not want to
manage group activities and prefer WWW staff to fulfill
that role. Participants can also engage in any one of
the optional programs, which adds another layer of
tracking that is required.
Participant engagement in HH-Online: WWW is
assessing the usefulness of implementing online HH
modules. Early challenges identified include internet
accessibility issues as well as resistance in older
adults to familiarizing themselves and becoming
comfortable with using the technology.
Partner Engagement: Almost all the WWW
partners are actively engaged in the network: They
participate in monthly meetings in-person or by phone,
provide input and resources in support of WWW, and
participate in decision-making related to the WWW
activities. The local school district was invited to
the partnership at the start of the current grant
period. However, due to staff turnover and internal
challenges, they have remained disengaged in WWW.
Partnership members need to strategize ways to
re-engage the school district.
COVID-19: COVID-19 provided unexpected
challenges to the WWW program. Both TOPS and HH are
in-person programs. Health educators came up with
creative ways of staying in touch with program
participants by using online conferencing platforms,
online HH modules, and one-on-one health coaching phone
A key factor to successful replication of community-based
partnerships and health programs is to involve
people/organizations from multiple sectors during the
planning and development stages. Incorporating
individuals from sectors not directly related to health
can bring a new perspective to the group.
WWW held annual meetings with all participants to provide
them feedback on the data and to celebrate their
successes. It was also an opportunity to hear participant
perspectives on the current program as well as get their
ideas for future efforts.
Manorama M. Khare, PhD, Director of the Division of Health Research and Evaluation
University of Illinois College of Medicine at Rockford
Community engagement and volunteerism
Obesity and weight control
Wellness, health promotion, and disease prevention
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about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
community should consider whether a particular project or approach is a good match for their community’s
needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.