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A Preconception Educational Intervention in a Community Health Setting

A Preconception Educational Intervention in a Community Health Setting. Nancy Khosa & Sarabeth Sheffler Drexel University School of Public Health Marjorie Angert & BrIan Castrucci Philadelphia Department of Public Health, Division of Maternal, Child and Family Health.

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A Preconception Educational Intervention in a Community Health Setting

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  1. A Preconception Educational Interventionin a CommunityHealth Setting Nancy Khosa & Sarabeth Sheffler Drexel University School of Public Health Marjorie Angert & BrIan Castrucci Philadelphia Department of Public Health, Division of Maternal, Child and Family Health

  2. Statement of the Problem • Despite a consistent decline in infant mortality rates nationally and locally, infant mortality in Philadelphia is 56% higher than the United States average • Significant racial disparities in infant mortality

  3. Trends in Infant Mortality Rate,United States, 1980-2001 Source: NCHS, 2001

  4. Trends in Infant Mortality Rate,Philadelphia, 1995-2002 Source: PDPH, 2003

  5. Background • The infant mortality rate is a marker of: • general well being • good health of a nation • More specifically, it is a marker of: • the quality of the health care system • accessibility to health care • adequacy of primary care

  6. Why Preconceptional Education? • The incidence of unplanned pregnancy in the U.S is 49 percent • 70 percent of pregnancies in women under 20 years of age are unplanned • Usual entry into prenatal care is 3rd month after last menstrual period • Most of the organogenesis occurs in first three months post-conception

  7. Role of Health Education • Review of 479 peer-review articles by Korenbrott et al. • Evidence for the efficacy of preconceptional care in terms of improving pregnancy outcomes • Recommended promoting preconceptional education among reproductive age couples

  8. Goals of this Study • To evaluate the need for preconceptional care education • To determine which is more effective in educating women about preconceptional risk factors: • written materials alone • written and video materials

  9. Issues Addressed • Nutritional Issues: General health, fitness, folic acid supplements, optimal weight at conception • Behavioral Issues: smoking, alcohol use, over the counter medications • Immunization issues: Rubella, Hepatitis B • Genetic risks: Familial, ethnic and racial

  10. Issues Addressed • Sexually transmitted diseases and HIV • Diabetes, hypertension, and epilepsy • Dental hygiene and urinary tract infections

  11. Educational Tools • Preconceptional education pamphlet from the March of Dimes • Video from the March of Dimes on preconceptional care

  12. Demographic Characteristics at Health Care Center # 5 • Serves a population of 34,935 people • Located in Lower North Philadelphia • Population • 96.0% African American • 1.8% White • The infant mortality rate for this area is 17.8 per 1000 live births

  13. Location ofHealth Care Center # 5

  14. Study Design and Methodology • Study was a randomized educational trial • Women were enrolled from the family planning section of Health Care Center # 5 • Baseline questionnaire administered to assess pre-intervention awareness of preconceptional care

  15. Inclusion and Exclusion Criteria • Inclusion • Women of reproductive age • Exclusion: • Men • Pregnant women • Women whose native language was not English • Women identified as being at high risk of adverse birth outcome

  16. Results and Data Analysis • 76 women between the ages of 18 and 45 were enrolled • 59.2% (n = 45) were 18 to 24 years old, 27.6% (n = 21) were 25 to 34 years old and 13.2% (n = 10) were 35 to 44 years of age

  17. Awareness of General Health and Nutritional Issues

  18. Awareness of Behavioral Issues

  19. Awareness of the Need for Prenatal and Dental Care

  20. Awareness of Sexually Transmitted Disease Issues

  21. Awareness of Medical Issues

  22. Intervention • All women received either • Written educational material • Written education material and watched a video • To date, only 20 women have completed post-test survey • Qualitative analysis pending • Early analysis reveals incremental gains in knowledge • Adequate data not available at this time to compare two study arms

  23. Intervention – Process Evaluation • Video • Too long • Not class, culturally sensitive • Need • 10 minutes • How to have a healthy baby • Appealing to urban audience

  24. Study Limitations • Low retention • Inability to enroll women under 18 years of age • Duration of preconception education video (30 minutes) • Instructions for follow up appointments were not always followed. • More educational sessions should have been devoted for health care provider education.

  25. Discussion • 53% were not aware of the importance of folic acid in preventing adverse birth outcomes • 80% did not believe being over weight could be detrimental to their infants • 27% did not know that you could safely become pregnant if you are HIV-positive

  26. Discussion • Continued focus on alcohol, tobacco and other drug cessation

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