Transcript Title Page

How to Effectively Communicate
Prevention Messages to
Women of Child-Bearing Age
The Statewide Parent Advocacy Network has
received funding for this project from the
New Jersey Department of Human Services,
Office for the
Prevention of Developmental Disabilities (OPDD)
Project Partners
 New Jersey Department of Health –
Division of Family Health Services
 New Jersey Department of Human
Services – Office for the Prevention
of Developmental Disabilities (OPDD)
 New Jersey Primary Care Association
TRAINING OVERVIEW:
 Part I: What is Prevention and Why is it
Important?
 Part II: Statistics
 Part III: Focus Group Results - Messaging
 Part IV: Recommendations
 Part V: Resources
Training Goals:
 Why is prevention important and how does it
relate to the Life Course Perspective
 Identify strategies for communicating with
diverse women
 Understand cultural barriers and how they
relate to women’s ability to access healthcare
 Learn about resources and supports for diverse
women
Project Overview
To educate health care providers to effectively
communicate culturally, linguistically, and socioeconomically relevant prevention messages to
their female patients of childbearing age
(especially those women at greatest risk of having
a child with birth defects/developmental
disabilities), with the long-term goal of positively
impacting the behavior of such women in ways
that reduce birth defects and developmental
disabilities.
Our project goals are to:
 Strengthen the capacity of health care provider practices to
effectively communicate culturally, linguistically, and socioeconomically relevant prevention messages to their female
patients of childbearing age
 Emphasize the importance of overall health and prenatal care for
all women of childbearing age
 Improve access to culturally, linguistically, and socio-economically
relevant prevention information, resources, and support for diverse
women of childbearing age and improve partnerships between
primary care providers and their diverse patients of child bearing
age
 To positively impact the behavior of such women, in ways that
reduce birth defects that cause developmental disabilities.
 Women will be connected to a Family Resource Specialist (FRS) by
a participating healthcare provider based on need for follow-up
support
THE NEED
FOR
PREVENTION
MESSAGING
Why focus on prevention?
 According to the Centers for Disease Control &
Prevention, birth defects affect 1 in 33 babies and are
a leading cause of infant mortality in the United
States.
 In New Jersey, birth defects affect 1 in 20 babies: more
than 8,000 babies a year.
 In the U.S., more than 5,500 infants die each year
because of birth defects, which is twice as many as
from sudden infant death syndrome (SIDS).
 In New Jersey, about 85 infants die each year due to
birth defects, more than twice as many as from SIDS.
Infant Mortality Rate by Leading Causes of Death, New Jersey, 2004-2008
(most recent data)
Infant mortality rates in US
 In 2010, the infant mortality rate was 6.1 deaths
per 1,000 live births. In 2005 the infant mortality
rate was 6.9.
 Between 1995 and 2005, the infant mortality
rate in the United States declined more than 9%.
US Department of Human Services
Centers for Disease Control and Prevention
National Department of Health Statistics
National Vital Statistics System
Infant Mortality Rates
Infant Mortality Rate by Mother's Race/Ethnicity,
New Jersey, 2000-2008 (HNJ2010/HNJ2020)
Low birth rates
 In 2010, 8.1% of babies born in the US
weighed less 2,500 grams compared to 8.3%
in 2006.
 In 2011, the rate of babies born with low birth
weight was 8.5% (9,005) and was 8.5%
(9,850) in 2007.
FOCUS
ON
OVERALL HEALTH
Healthy Habits are Important
 50% of pregnancies in the United States are
categorized as unintended
 Healthy women have a higher likelihood of
healthy outcomes
 The health status and habits of women in the US
places them at risk for short and long term
morbidities and early mortalities
 Promoting high levels of health in all women is
likely to result in preconceptional health
promotion for those who become pregnant
Examining the Link between
Promoting Women’s Health and Promoting
Preconceptional Wellness
Major threats to women’s health are also
major threats to reproductive outcomes.
Focus on overall health
 Access to early prenatal care must also focus on
women before they become pregnant through the
promotion of preconception care and family
planning services.
 Health and well being that focuses on nutrition is
an essential component to preconception and
interpregnancy care.
Healthy habits are important!
 Healthy diet
 Women need to eat fresh fruits, vegetables, and whole
grains.
 Cut down on the sugar!
 They also need plenty of folic acid, iron, and calcium –
through food, and in a multi-vitamin.
 Get Plenty of exercise
 Women don’t have to go to the gym to exercise.
 Exercise reduces stress.
 And if you do get pregnant, being a healthy weight
reduces the chance of having a baby with a heart defect
or other birth defect.
 Mental health
 mental health is just as important as a woman’s physical
health.
The importance of Folic Acid
 Inadequate maternal folate levels can
cause:
 Increased incidence of neural tube
defects
 Increased incidence of other birth
defects
 Some anemias—mother and infant
COMMUNICATING
HEALTH MESSAGES
Communicating Health Messages
 Age of woman

teens versus older women
 Family circumstances


marriage status
support system
 Health Literacy

ability to read & comprehend health
related information
 Culture/linguistic context

relevant to a woman’s culture
 Socio-economic status
Communicating Health Messages
Health Literacy - health literacy affects
people’s ability to:
 Share personal and health information with
providers
 Understand instructions on prescription drug
bottles and nutrition labels
 Manage chronic health conditions
 Understand how to locate and access
affordable health care for themselves and
their children.
Communicating Health Messages
Culture/linguistic context - culture includes
how people think, what they do, and how they
use things to sustain their lives. Audiences do
not speak our professional jargon and that
culture influences how people communicate,
understand, and respond to health
information.
Socio-economic - factors such as education,
employment and income influence
preconception health.
PRECONCEPTION HEALTH
MESSAGES
Preconception Health
 Components – There are many things to
consider when addressing preconception
health.
 Risk factors
 Obesity
 Drugs - Prescription & Street
 Smoking
 Alcohol
 Folic Acid
 Environmental exposures
 Genetic risk factors
 Previous negative pregnancy Outcomes
Taking Care of
Preconception Health
 The Physician’s Role-The concept of
preconception care has been articulated for well
over a decade but has not become part of the
routine practice of family medicine. Because all
women of reproductive age presenting to the
primary care setting are candidates for
preconception care, the essential and critical role
of family physicians in the provision of
preconception care is apparent.
 The Woman’s Role-All women can benefit from
preconception health, whether or not they plan to
have a baby one day. This is because part of
preconception health is about people getting and
staying healthy overall, throughout their lives.
How Does the physician fit
Preconceptional Health Promotion into an Encounter?
If you take care of women of reproductive
potential . . .“It’s not a question of whether
you provide preconception care, rather it’s a
question of what kind of preconception care
you are providing.”
Joseph B. Stanford and Debra Hobbins
Practice level changes
•
•
Small changes can make a big impact on a
woman’s overall experience.
Here are some comments from the women we
spoke to:
•
•
•
visits often feel rushed and cold
office hours not always convenient
waiting time is too lengthy
Tips for Physicians
 Take time to really listen to your patients
 Ask questions
 Write a note about the patient’s life so you
have something to talk about
 Be open and don’t show your personal
judgment
 be supportive
 Share relevant information and updated
resources
 websites, brochures, books
Communication is Key!
 Listen!
 More personalized
 Take notes
 Partnership
 Trust
Barriers for women
 Lack of insurance
 Literacy level
 Transportation
 Childcare
 Lack of trust
 Support system
Focus Group Overview
 Total of 6 Focus groups
 Teens (7)
 College-Age (12)
 Older women




African American women (13)
Arab American women (7)
South Asian women(8)
Spanish speaking women (10)
 Total number of women who participated
 57 women

between the ages of 14 years – 52 years
Common Themes
 Establishing a positive, trusting relationship
between patient and physician is key
 Trust
 Communication
 The women prefer to get their health information
directly from their healthcare provider.
 Women prefer friendlier doctors who show more
concern
Women want more feedback about test results and
what they mean
• Women want to spend more time with their health
care provider

They don’t want to have to tell the same thing to multiple
people
More Common Themes
visits
often feel rushed and cold
office hours not always convenient
waiting time is too long
don’t take a multi-vitamin
time to exercise
Teens (14 years-18 years)
 Topics discussed
 Nutrition and Exercise
 Mental health
 Sexuality
Tips for Communicating with Teens
 Make sure the message is relevant to their
lifestyle and that the media used to convey
them resonate with teens and their peers.
 Make sure to take into account their
attitudes, opinions, knowledge, and
behaviors
 Talk with teen and parent about who
should be in the room during the visit and
conversation
 Don’t stop the conversation when a young
women says no!
Tips for Communicating with Teens
 Don’t dismiss a topic of discussion because
the teen is currently not involved in that
specific activity
 Alcohol- just because a teen is underage doesn’t
mean she doesn’t drink
 Nutrition & Physical health-Importance of eating
right and vitamin supplements


None of the teens are taking Folic Acid
Most not interested in exercise
 Sexuality-teens stated that they want information
about different types of contraceptives
 Mental health-provide information about anger
management and stress management
College-age women (19 years-23 years)
 Nutrition and Exercise
 Mental Health
 Sexuality
 Lesbian, Gay, Bi-sexual, Questioning, and
Transgender/Transsexual (LGBQT)
Tips for communicating with
College-age women
 Want to see videos utilized for health
messages
Arab American Women
 Health & Exercise
 Fasting
 Discuss with a woman as to why she is fasting and
what that means for her



Religion
Health
Discuss concerns and the impact on a woman’s health
 Related to other health conditions
 Risks associated with fasting
 Culture
 New generation

Don’t make cultural assumptions
 younger generation more Americanized
Tips for Communicating with
Arab American Women
 Health & Exercise
 Fasting
 Discuss with a woman as to why she is fasting and
what that means for her



Religious
Health
Discuss concerns and the impact on a woman’s health
 Related to other health conditions
 Risks associated with fasting
 Culture
 New generation

Don’t make cultural assumptions
 younger generation more Americanized
South Asian Women
 Health and wellness
 Fasting
 Discuss with a woman as to why she is fasting and
what that means for her



Religious
Health
Discuss concerns and the impact on a woman’s health
 Related to other health conditions
 Risks associated with fasting
 Messaging
 All used internet
Tips for Communicating with
South Asian Women
 Health & Wellness
 Fasting

Discuss with a woman as to why she is fasting and
what that means for her
 Religious
 Health
 Discuss concerns and the impact on a woman’s
health
 Related to other health conditions
 Risks associated with fasting
African American Women
 More information
 Older women want to be provided with choices

Benefits versus risks
 Testing options
 Midwives
 Hospital setting
 Dulla
 Home birth
 Holistic
 Barriers

Childcare, transportation, lack of support from father,
literacy issues
Tips for Communicating with
African American Women
 Do not make assumptions
 Listen to the individual needs of each woman
 Communicate test results to women during
pregnancy
 Seek advice of older family members
 Interested in holistic methods of healthcare
Spanish speaking Women
 Need to build trust first
 Health literacy
 Many don’t understand the language used or
have a lower reading level than information
presented to them
 No/limited insurance coverage
 Don’t regularly see a doctor
 Typically get their healthcare services at
federally qualified health centers (FQHC’s)
 Tend to have more barriers
 transportation
 childcare
Tips for communicating with
Spanish speaking women
 Ask women what they need to help establish
trust
 Identify literacy level and communication needs


Interpreter
Translation of health information
 Provide ??????
Improving Preconception Health
 Recommendations
 Individual Responsibility Across the Lifespan – parental
responsibilities for pre-teen girls

Each woman, man, and couple should be encouraged to have a
reproductive life plan.
 Consumer Awareness
 Increase public awareness of the importance of preconception health
behaviors and preconception care services by using information and
tools appropriate across various ages; literacy, including health
literacy; and cultural/linguistic contexts
 Preventive Visits
 As a part of primary care visits, provide risk assessment and
educational and health promotion counseling to all women
of childbearing age to reduce reproductive risks and improve
pregnancy outcomes.
 Interventions for Identified Risks

Increase the proportion of women who receive interventions as
follow-up to preconception risk screening, focusing on high priority
interventions (i.e., those with evidence of effectiveness and greatest
potential impact).
Improving Preconception Health
 Interconception Care
 Use the interconception period to provide additional
intensive interventions to women who have had a
previous pregnancy that ended in an adverse outcome
(i.e., infant death, fetal loss, birth defects, low birth
weight, or preterm birth).
 Pre-pregnancy Checkup
 Offer, as a component of maternity care, one prepregnancy visit for couples and persons planning
pregnancy
 Public Health Programs and Strategies
 Integrate components of preconception health into
existing local public health and related programs,
including emphasis on interconception interventions for
women with previous adverse outcomes.
 Research
 Increase the evidence base and promote the use of the
evidence to improve preconception health.
Life Course Model
Individual Responsibility
Across the Lifespan - Each
woman, man, and couple should
be encouraged to have a
reproductive life plan.
Consumer Awareness
Increase public awareness of the
importance of preconception
health behaviors and
preconception care services by
using information and tools
appropriate across various ages;
literacy, including health literacy;
and cultural/linguistic contexts.
PROJECT RESOURCES
Resources for Physicians
 Referral to a Family Resource Specialist for
women patients
 Resource Binder
 Variety of resources on prevention of birth
defects, healthcare financing, mental health,
dental, transportation, support groups
 Technical assistance webinars
Resources for Women
 Follow-up support by a Family Resource
Specialist
 Healthy Changes Plan
 Peer Support
 Community Resources
QUESTIONS?
Contact Info.
Malia Corde, Project Director
Statewide Parent Advocacy
Network
35 Halsey Street, 3rd Floor
Newark, NJ 07102
908-208-4040 (cell)
[email protected]
www.spannj.org
Nicole Pratt, Assistant
Coordinator
Statewide Parent Advocacy
Network
35 Halsey Street, 3rd Floor
Newark, NJ 07102
973-642-8100 X 122
[email protected]
www.spannj.org