An example of a preconception health message: North Carolina Folic Acid Campaign

1. An example of a preconception health message:North Carolina Folic Acid Campaign LaToya Artis, Cape Fear Regional Coordinator NC Folic Acid Council October 28, 2009

2. About the Folic Acid Campaign • The North Carolina Folic Acid Campaign is a statewide program whose mission is to improve health by promoting the benefits and consumption of folic acid

3. The goal of the Campaign • Is to reduce the number of pregnancies affected by neural tube birth defects (NTDs), such as spina bifida and anencephaly

4. Objectives • To increase women’s awareness of folic acid’s role in preventing birth defects • To increase the percentage of women of childbearing age who take a multivitamin containing folic acid every day

5. Our target audiences • All women of childbearing age • Specific marketing messages around • Women ages 18-24 who are not planning a pregnancy • Women ages 18-24 who are planning a pregnancy • Latino/Hispanic women

6. Folic acid: A preconception message • Folic acid deficiency identified as a preconception risk factor in the CDC’s 2006 guidelines • If taken BEFORE pregnancy, folic acid can prevent up to 70% of spina bifida and anencephaly • The U.S. Public Health Service recommends that ALL women of child bearing age take 400 mcg of folic acid every day

7. Folic Acid Campaign methods • We disseminate our preconception health message through… • Media - TV, radio, print • Free materials – brochures, reminders, videos, bulletin boards, etc • Health Care Provider Education - Office Champion • Peer education- Community Ambassador Program • Latino Campaign • Integration of message into existing programs/services

8. Office Champion Program • We provide an in-service about folic acid to family practice and Ob/GYN • The training for all staff includes basic folic acid facts and how and when to talk with female patients about this topic • A nurse or other staff member is appointed the “Office Champion” • The Office Champion helps remind clinicians to talk to female patients about folic acid and keeps the practice stocked with educational materials for patients Program reaches more than 250 practices each year

9. Office Champion Program: Results • Comparing provider knowledge before and after the folic acid in-service: • Proper timing of folic acid supplementation: 87% of respondents answered correctly (at least one month before conception) before the in-service and 94% after the in-service. North Carolina providers have high knowledge about the importance of taking folic acid before pregnancy. • Correct folic acid daily dose: Improvement from 53% to 73% of respondents who correctly identified 400 mcg. • Correct recurrence prevention dose: Improvement from 24% to 45% of providers who knew that 4000 mcg before pregnancy is the correct dose to prescribe if a patient has a history of a prior NTD-affected pregnancy. • The proportion of providers who reported discussing folic acid and multivitamin use with at least half their female patients of childbearing age at annual exams jumped from 51% before the in-service to 69% afterward.

10. Community Ambassador Program • Basic health promotion program • Community groups or individuals • Regional coordination • Community Ambassadors are: • Motivated individuals • High school or college students, employees at a company, members of churches, neighborhood moms, hair stylists, etc. • Individuals that represent the diversity of the community Program reaches more than 10,000 individuals each year

11. Community Ambassador Program: Results Pre-test/ Post-test Results for Level of Importance Placed on Taking Daily Multivitamins

12. Latino Campaign • Developed in response to increased risk for NTDs among Latinas. • Health care provider education, including cultural competency workshops • Educational materials are NOT direct translations; they are modified to be culturally appropriate • Community ambassadors present to small groups of women • Statewide Spanish-language media

13. Latino Campaign: Results • From 2006 to 2008, knowledge of multivitamins and folic acid increased significantly in North Carolina Hispanic women ages 18 to 35, but overall still remains low. • Hispanic women knew that a prescription is not necessary to buy multivitamins and that the best time to start taking a multivitamin every day is when young women first get their period. • More Hispanic women knew that taking a daily multivitamin with folic acid could prevent a birth defect, but the same percent were taking a multivitamin as compared to the women surveyed in 2006.

14. Prevalence of Neural Tube Defects North Carolina, 1995-2005*N.C. Birth Defects Monitoring Program *2004-2005 data are provisional

15. Lessons learned: planning • Materials development • Make sure audience participates in development and review of materials • Work with partners at all agencies involved so that process goes smoothly • Give yourself enough time for many rounds of approvals

16. Other successes • Helped to introduce and pass legislature that will provide multivitamins to low income women of childbearing potential • Received a grant from the CDC to test a “Promotora” curriculum that is much like the Latino Campaign’s model

17. Lessons learned: partnerships • Partnerships are important • Partnerships allow for leverage and expand resources beyond our capacity • Find partners with compatible messages • Partnerships can be tricky and time-consuming

18. Lessons learned: partnerships • Non-traditional partners are essential • Media • Difficult to measure but much broader reach than public health reaches alone • Media partners look for opportunities to work with positive messages • Community-based organizations • Schools and students

19. Lessons learned: women • Do not assume that women will be moved by our public health messages • Knowledge does not necessarily lead to action • Listening (and adapting) is important: women talk about competing priorities, barriers, stress, etc.

20. Lessons learned: women • Most women don’t think much about pregnancy before it happens. • So . . . consider other ways to talk about preconception messages • Spanish-speaking women are receptive to pregnancy messages

21. Looking to the future • Partnering with other organizations and agencies (e.g. schools) • Combining the folic acid message with other preconception health messages • Funding opportunities

22. Ideas? Questions? Contact us!

23. Join us! • www.getfolic.com • www.marchofdimes.com/northcarolina • Blogger: http://getfolic.blogspot.com/ • Myspace: www.myspace.com/getfolic • Facebook: http://www.facebook.com/pages/North-Carolina-Folic-Acid-Campaign/16803568463 • Twitter: www.twitter.com/getfolic • Youtube: www.youtube.com/getfolic

24. Contact us By spreading the word about folic acid and multivitamins…YOU can make a difference for mothers and babies! For more information contact: LaToya Artis Megan Whelen Cape Fear Regional Coordinator Triad Regional Coordinator 910-822-3004 336-723-4386 lartis@marchofidimes.commwhelen@marchofdimes.com Gina Smith Linda Morgan Eastern Regional Coordinator Western Coordinator 252-972-4900 828-213-0031 gsmith@marchofdimes.comcgclmm@msj.org