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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Well-Woman Visit.

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Strategy. Engagement of Other MCH Programs to Disseminate Information and Make Referrals for Well-Woman Visit

Approach. Provide education on the importance of the well-woman visit to other MCH programs such as WIC, Healthy Start, MIECHV and other home visiting programs; encourage these programs to make referrals or visits

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Overview. Educational materials focused on the well-woman visit can be integrated into the educational efforts of MCH programs, such as WIC, Healthy Start, MIECHV, and other home visiting programs. These programs can provide specific interventions to connect women to their primary care provider, a medical home, and insurance coverage. It is important to track the use of preventive annual care by evidence-based program, if possible. Note: while these programs do not serve all women, they do serve women with the lowest rates of use of the well-woman visit.[1]

Evidence. Expert Opinion. Strategies with this rating are recommended by credible, impartial experts...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Meeting minutes around program collaboration
  • Referral Tracking Systems and Data sharing agreements
  • Performance reports and program-specific data

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Health Teaching (Education and Promotion) (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of MCH programs (e.g., WIC, Healthy Start, MIECHV) provided with education on the importance of well-woman visits. (Measures the extent of outreach to key MCH partners)
  • Number of educational materials on well-woman visits distributed to MCH program staff that incorporate health literacy principles. (Measures the dissemination of usable and relevant information)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of referral protocols that adhere to best practices for warm handoffs and closed-loop communication between MCH programs and healthcare providers. (Measures the quality and effectiveness of referral process)
  • Percent of educational materials that have been reviewed and validated by community members and MCH program participants. (Measures the community-informed nature of the materials)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of cross-training sessions conducted for healthcare providers and MCH program staff to enhance care coordination for well-woman visits. (Measures efforts to build integrated systems of care)
  • Number of MCH program sites that have incorporated well-woman visit education and referrals into their standard operating procedures. (Measures the institutionalization of the strategy within MCH programs)
  • Number of women referred by MCH programs who receive recommended screenings and immunizations during their well-woman visits. (Measures the completion of key preventive services facilitated by referrals)
  • Number of women with chronic conditions or risk factors identified during well-woman visits resulting from MCH program referrals. (Measures the role of referrals in early detection and intervention)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of MCH programs that have implemented evidence-based strategies for increasing well-woman visit rates among women. (Measures the adoption of tailored, population-focused interventions)
  • Percent of MCH program staff and healthcare providers who receive ongoing training and quality improvement initiatives related to well-woman visit promotion. (Measures commitment to continuous learning and improvement)
  • Percent increase in well-woman visit rates among women served by MCH programs, compared to baseline. (Measures progress toward preventive care access)
  • Percent reduction in the gap between well-woman visit rates for women referred by MCH programs and the general population. (Measures the effectiveness of tailored referrals in closing gaps)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] This strategy is based on Analogical Evidence; this refers to those strategies that have proven effective in similar topic areas and are likely to be effective in other settings (e.g., provider training is a strategy that is likely effective to advance all topic areas). It is reasonable to assume that this strategy will also prove effective with a related measure, but additional research is needed. In adapting this strategy, you may want to start with a pilot group, collect data, and evaluate to ensure impact with this topic area and your population group(s). Evidence for this strategy is drawn from these similar approaches:

Integrating Breastfeeding into Home Visiting:
McGinnis, S., Lee, E., Kirkland, K., Miranda-Julian, C., & Greene, R. (2018). Let's talk about breastfeeding: The importance of delivering a message in a home visiting program. American Journal of Health Promotion, 32(4), 989-996.
Kronborg, H., Væth, M., Olsen, J., Iversen, L., & Harder, I. (2007). Effect of early postnatal breastfeeding support: a cluster‐randomized community based trial. Acta Paediatrica, 96(7), 1064-1070.
Mackrain M, Fitzgerald E, Fogerty S, Martin J, O'Connor R, Arbour M. The HV CoIIN: implementing quality improvement to achieve breakthrough change in exclusive breastfeeding rates within MIECHV home visiting. MIECHV TACC, June 2015

Integrating Developmental Screening into Home Visiting:
Green B, Tarte JM, Harrison PM, Nygren M, Sanders M. Results from a randomized trial of the Healthy Families Oregon accredited statewide program: early program impacts on parenting. Child Youth Serv Rev. 2014;44:288-298.

Integrating a focus on Child Safety/Injury Prevention into Home Visiting:
Filene, J. H., Kaminski, J. W., Valle, L. A., & Cachat, P. (2013). Components associated with home visiting program outcomes: A meta-analysis. Pediatrics. 132(0 2), S100-109. doi: 10.1542/peds.2013-1021H.

Integrating Oral Health Component through the WIC Program:
Lipper, J. Advancing Oral Health through the Women, Infants, and Children Program: A New Hampshire Pilot Project. Center for Health Care Strategies, 2016. https://www.chcs.org/media/NH-State-WIC-Profile_041316.pdf

Integrating WIC and Immunization Services:
Shefer, A., Fritchley, J., Stevenson, J. et al. Linking WIC and Immunization Services to Improve Preventive Health Care among Low-income Children in WIC. Journal of Public Health Management and Practice, 2002; 8(2): 56-65. https://journals.lww.com/jphmp/Fulltext/2002/03000/Linking_WIC_and_Immunization_Services_To_Improve.8.aspx

Integrating Women's Health Care into the Well-Baby Visit:
Caskey R, Stumbras K, Rankin K, Osta A, Haider S, Handler A. A novel approach to postpartum contraception: A pilot project of pediatricians' role during the well-baby visit. Contracept Reprod Med. 2016;1:7. Srinivasan S, Shlar L, Rosener S, Frayne D. Delivering interconception care during well-child visits: An IMPLICIT network study. J Am Board Fam Med. 2018;31(2), 201-10.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.