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 Adverse effects of drinking: Beneficial effects of exercise: Adverse effects of mercury:

Baseline

N (%)

Follow-up

N (%)

166/297 (56%) 158/212 (75%)

142/293 (48%)

244/282 (87%)* 189/212 (89%)* 256/276 (93%)*

* P < 0.001

Pilot Evaluation Results Self-efficacy answered “definitely”* I understand steps to take before getting pregnant I can find the needed resources to have a healthy baby

Baseline N (%)

Follow-up N (%)

137/296 (46%) 160/300(53%)

217/280 (78%)†

214/281 (76%)†

* On a 5-tiered likert scale, † P < 0.001

Evaluation Results

Access to services DH clinics provide care to those without insurance: Obtaining family planning at DH is “definitely” easy:†

Baseline N (%)

Follow-up N (%)

207/297 (70%) 31/204 (15%)

252/283 (89%)* 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 1st National Summit 2005

• Discovered PPOR had triggered numerous activities

• 4 workgroups: Clinical, Public Policy, Public Health and Consumer/Social Marketing

• 2nd Summit 2007, 3rd 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

Elizabeth W. Mitchell, PhD

Division of Birth Defects and Developmental Disabilities

June 13, 2011

Developing a National Social Marketing Plan for Preconception Health and Health Care:

Perspectives from the Consumer Workgroup

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

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Contact

Linda Squiers, Ph.D. Senior Research Scientist

RTI International 919-597-5128

lsquiers@rti.org

RTI International

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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

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