Denver s Preconception Project: A Community-Based, Consumer- Focused Pre/Interconception Health Intervention

Denver s Preconception Project: A Community-Based, Consumer- Focused Pre/Interconception Health Intervention

Current Intervention Two hour session 90 min content Pre and Post test Highly pictorial, reflective presentation Follows journal/booklet ( RLP like ) Selected topics focus on weight, folic acid and contraception

Intervention Logic Poor birth outcomes persist despite availability of medical care An algorithm of risk indicators and mapping shows neighborhoods with highest risk factors Community leaders and CBOs are uniquely effective in reaching more vulnerable women Consumers must play a stronger role in elevating preconception health as a primary prevention strategy

Intervention Goals Educate reproductive age women (13-50 years) on the importance of preconception health (knowledge) Offer assistance in self-management approaches for avoiding adverse birth outcomes (behaviors) Provide information and encouragement on accessing community resources and health care for improved wellbeing (self-efficacy)

Pilot Program Development Iterative, cyclical, consumer focused Principles from Community Based Participatory Research (CBPR) Community input on broad concepts and fine details of intervention Key informant /small group interviews Presented focus group style to sample audiences Groups appreciated opportunity

Pilot Evaluation Results Knowledge of how factors can affect contraception and pregnancy Baseline N (%) Follow-up N (%) Adverse effects of drinking: 166/297 (56%) 244/282 (87%)* Beneficial effects of exercise: 158/212 (75%) 189/212 (89%)* Adverse effects of mercury: 142/293 (48%) 256/276 (93%)* * P < 0.001

Pilot Evaluation Results Self-efficacy answered definitely * Baseline N (%) Follow-up N (%) I understand steps to take before getting pregnant 137/296 (46%) 217/280 (78%) I can find the needed resources to have a healthy baby 160/300(53%) 214/281 (76%) * On a 5-tiered likert scale, P < 0.001

Evaluation Results Access to services Baseline N (%) Follow-up N (%) DH clinics provide care to those without insurance: 207/297 (70%) 252/283 (89%)* Obtaining family planning at DH is definitely easy: 31/204 (15%) 52/196 (27%)* *P < 0.001 on a 5-tiered likert scale

Current Activities Revised intervention to be an asset-based approach to preconception health Developing Training of Facilitators (TOF) for community based organization (CBO) staff Recruit community partners to be trained and then deliver the sessions Develop program quality (fidelity) measures Revise and enhance evaluation Document Pilot to Community Program process

Context for Preconception Work CDC Select Panel published findings in MMWR and 1 st National Summit 2005 Discovered PPOR had triggered numerous activities 4 workgroups: Clinical, Public Policy, Public Health and Consumer/Social Marketing 2 nd Summit 2007, 3 rd Summit 2011

Influences on Denver s Project Practice/Learning Collaborative reports Market analysis and segmentation http://www.beforeandbeyond.org/ Applications of social marketing/ social norming Availability of Behavioral Training Intervention experts in PTC

Developing a National Social Marketing Plan for Preconception Health and Health Care: Perspectives from the Consumer Workgroup Elizabeth W. Mitchell, PhD Division of Birth Defects and Developmental Disabilities June 13, 2011 National Center on Birth Defects and Developmental Disabilities Division of Birth Defects and Developmental Disabilities

Key Challenges Half of all pregnancies are not planned* Target audience has a wide age range (18-44) and is diverse The list of PCH behaviors is long Messaging is challenging (language of PCH ; time period for promoting behaviors is unclear) Health disparities Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health2006;38(2):90-6

Short Term Communication Goals Planners (30%?) Increase awareness of PCH behaviors Increase awareness that there is a preconception time period Increase awareness that what they do before they get pregnant can affect the health of their baby Increase awareness about where to obtain information about PCH Non-Planners (70?) Increase awareness about being healthy (PCH) Increase awareness about contraception (RLP) Increase awareness about where to obtain information about women s health (PCH)

RTI International Contact Linda Squiers, Ph.D. Senior Research Scientist RTI International 919-597-5128 lsquiers@rti.org 17

RTI International Product Consumer Understanding Participants had a general understanding of PCH behaviors and their importance Limiting alcohol, quitting smoking, and taking prenatal vitamins were most salient, especially for planners Non-planners questioned the need to do these behaviors when not preparing for a pregnancy Recommendation for vaccinations (Rubella and Influenza) were confusing to some Overall, PCH perceived as a lifestyle (i.e. being healthy) rather than a set of services 18

Baby Yourself For Life

Health Behaviors: The Good

Be a Healthy Weight

Eat Healthy Portions

Move Your Body To Be Healthy

Health Behaviors: The Bad

Change Bad Behaviors to Good Behaviors

Lessons Learned Community project needs differ from pilot project CBO capacity different than expected Subject matter is complicated Appropriate staff needs to conduct trainings A menu of products may be best Single 90 minute session 5 session series 15 minute on the spot messages Social Marketing may provide approaches Resources on preconception health not centralized; extensive searching required

Implications Translating a pilot pre/interconception health program to an effective community-based training program potential of offering an effective method for increasing consumer-focused health education among at-risk populations If successful, this program could be offered in other communities

Developed by Judith Shlay, MD, MSPH, Beverly Tafoya-Domínguez, MS Theresa Mickiewicz, MSPH, Kellie Teter, MPA, Helen Burnside, MPH, Elisha Curtner MPH candidate Funding for this project provided by the Center for Healthy Families and Communities, Prevention Services Division, Colorado Department of Public Health and Environment, Maternal Child Health Block Grant. Additional information: Kellie Teter, MPA kellie.teter@dhha.org 303-602-3709