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

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

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

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

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

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

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

Office Champion Program

Program reaches more than 250 practices each year

• 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

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.

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

Community Ambassador Program: Results

Pre-test/ Post-test Results for Level of Importance Placed on Taking Daily Multivitamins Survey 1: How important is it for you to take a daily multivitamin?

Survey 2: After hearing the presentation today, how important do you now think it is to take a daily multivitamin?

Very important (20.9%) Important (35.7%) Not very important (27.6%) Not at all (15.7%) 96.7% maintained very important 80.5% shifted to very important 19.5% maintained important 56.9% shifted to very important 38.2% shifted to important 52.9% shifted to very important 38.6% shifted to important

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

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.

Prevalence of Neural Tube Defects

North Carolina, 1995-2005* N.C. Birth Defects Monitoring Program

12.0

10.0

8.0

6.0

4.0

2.0

0.0

1995 1996 1997 Anencephaly 1998 1999 2000 2001 2002 Spina Bifida 2003 2004 2005 Encephalocele Total NTDs

*2004-2005 data are provisional

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

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

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

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

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.

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

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

Ideas? Questions?

Contact us!

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

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 Cape Fear Regional Coordinator 910-822-3004 [email protected]

Gina Smith Eastern Regional Coordinator 252-972-4900 [email protected]

Megan Whelen Triad Regional Coordinator 336-723-4386 [email protected]

Linda Morgan Western Coordinator 828-213-0031 [email protected]